Roe is gone and pills are here to fill in the gaps. But we still need clinics.
A few years ago, on a subway platform, I explained to some friends the difference between abortion pills and the Morning After Pill. The listeners were women I knew, abortion positive and regular consumers of news, but unaware that abortion pills were not the same as Plan B, which prevents pregnancy when taken up to 72 hours after unprotected sex and does not work if a person is already pregnant.
Yet we all agreed that abortion pills, typically a combination of mifepristone and misoprostol, were a game changer – pregnant people could now self manage their own abortions at home, safely and effectively, without having to worry about accessing a clinic that may be impossible to get to.
For those living in rural areas, those in abusive relationships, those who are young and can’t tell their parents or guardians that they’re pregnant, trans and non-binary people who don’t want to have to clarify their gender identity when they’re just trying to get a common medical procedure, those who couldn’t leave their houses during COVID, and those who are most comfortable when literally taking their health care into their own hands, self-managed abortion is a relevation.
And the fact that more people know about abortion pills now than ever before is an enormous victory, especially with the SCOTUS decision today overturns Roe v. Wade, and will result in the shutting down of clinics in 26 trigger states, which, once Roe is no longer considered law, will ban abortion.
But, at the same time, the existence and availability of abortion pills must not eclipse the fact that in-clinic abortions must remain accessible.
Abortion pills aren’t a panacea. Not everyone feels great about administering their own abortion. While abortion pills are incredibly effective, it may be unnerving for some to anticipate the side effects of misoprostol, one element of the abortion pill, which may include flu-like symptoms such as vomiting, diarrhea, a low fever, headache, and chills.
An in-clinic abortion takes less time than one with pills, and a health care provider can confirm if the abortion is complete while the patient is still in the clinic, whereas with abortion pills, it’s a bit more complicated. If an abortion pills are used successfully, and one had pregnancy symptoms before using the pills, the symptoms should go away within a few days. However, not everyone has pregnancy symptoms, so one is advised to wait 4 weeks to take a home/urine pregnancy test, since HCG, the pregnancy hormone, takes time to leave the body, or take a blood pregnancy test sooner than that.
Additionally, abortion pills are safest and most effective when used to terminate an early pregnancy— up to 12 weeks. And if someone doesn’t have pregnancy symptoms, she may not know she is pregnant until well past this point, making the pills irrelevant. Then there’s the reality of the law limiting the use of abortion pills, which are likely to be augmented with the disappearance of Roe. In 32 states, the pills must be administered by a physician. Not a nurse or another person who works in the clinic, but a medical doctor. There is no medical reason for this; rather, it’s an example of how abortion stigma, the perpetuation of misinformation about abortion and those who perform them and get them, has seeped its way into law-making.
In 19 states, telemedicine abortion is either restricted or completely banned, meaning that one must actually travel to the clinic to receive abortion pills from someone and take mifepristone in front of the them, instead of obtaining the pills and taking them with the guidance of a clinician via a Zoom call.
Abortion pills are a safe and essential option for abortion care, but they are not ideal for everyone.
That’s the thing, and that’s why we need safe, legal and widely accessible aboriton: there is no one-size-fits-all model of abortion care, and there shouldn’t be. Everyone who needs an abortion should be able to have the abortion they choose, not the one they are forced to choose based on coercion or desperation, whether it takes place on their couch or in a procedure room in a clinic. Every kind of abortion must remain accessible and free of stigma, and that means it’s vital for clinics and providers to be protected.