The Supreme Court’s overturning of Roe v. Wade has paved the way for more than half of U.S. states to outlaw abortion. As we look to the future of abortion in the U.S., we can learn from the experiences of people in countries with restrictive abortion laws who have managed to find safe, effective ways to have abortions by using the original abortion pill: misoprostol.
In the 1980s, Brazilians discovered that an ulcer medication, misoprostol, could induce a miscarriage by causing contractions of the uterus to expel a pregnancy. Across Latin America, women and other people who can become pregnant began to use misoprostol to manage their own abortions. Infection, hemorrhaging and death from unsafe abortion declined precipitously.
The World Health Organization recommends two regimens for medication abortion: misoprostol alone or combined with another medication, mifepristone, which blocks the hormone progesterone to end a pregnancy. Today, in countries where abortion is legally available, misoprostol is most commonly used together with mifepristone. But where abortion is legally restricted, misoprostol is often used alone for self-managed abortion because it is inexpensive and widely available, often over the counter (unlike mifepristone).
Around the globe, grassroots feminists have organized abortion support such as safe-abortion hotlines for those who are self-managing abortions, often with misoprostol alone. Study after study has found that self-managed abortion with misoprostol is more than 90 percent effective.
Why, then, are most clinic-based abortions performed using misoprostol in combination with mifepristone? For one, early clinical trials showed that misoprostol was less effective alone than in combination with mifepristone—but recent evidence on self-managed use of misoprostol alone suggests otherwise.
Differences in patients’ experiences using the two regimens may also be a contributing factor. The side effects from misoprostol can include nausea, fever, chills, vomiting and diarrhea. Because the misoprostol-alone regimen calls for multiple doses of misoprostol (as opposed to one if combined with mifepristone), those who use this regimen may experience these side effects more frequently and/or with more severity.
Women and other people who can become pregnant should have access to the method of abortion care that works best for them, but in many settings, including here in the U.S., barriers to abortion may mean that clinic-based medication abortion with mifepristone is not accessible or even preferable. Studies have shown that regardless of the regimen, patients can have positive abortion experiences when they have access to the information they need, feel prepared for what they will experience and are supported through the process.
So what does this mean for the future of abortion in the U.S.? While mifepristone is expensive and unnecessarily restricted by the U.S. Food and Drug Administration, misoprostol is inexpensive and widely available by prescription for different indications in pharmacies across the country.
Plan C, SASS (Self-Managed Abortion; Safe and Supported) and Reprocare provide information about where and how to get abortion pills in the U.S. The Miscarriage and Abortion Hotline offers free, compassionate and confidential medical support for anyone who would like to speak to a trained medical professional when self-managing an abortion. Organizations such as Las Libres, which has supported self-managed abortion in Mexico, are now providing misoprostol pills, information and support to those in the U.S.
Under abortion bans and restrictions, police and prosecutors are most likely to target people who are already criminalized and surveilled, including those who are low income, Black/Indigenous/of color, immigrant and undocumented. For information and support with legal questions about self-managed abortion, contact the Repro Legal Helpline, or access bail and legal counsel through the Repro Legal Defense Fund. The Digital Defense Fund offers detailed information about how to protect one’s identity when searching for abortion pill information and purchasing medications online.
For decades, women living in countries where abortion is restricted have self-managed their abortions in a safe, affordable way using misoprostol alone. In light of Dobbs, many in the U.S. will no doubt follow their lead. And feminists will be there to support them when they do.