The future of abortion pill activism
What US activists can learn from Irish feminism
The end of 2021 saw the passage of state-level bills effectively banning abortion at “pre-viability” gestational ages, undermining the right to abortion protected by Roe v. Wade. While the country awaits a ruling on the constitutionality of such laws, abortion providers are unable to lawfully provide abortions to their patients, and activists are scrambling to fill in these gaps in access. In the wake of this crisis, many have suggested that abortion pills sent by mail are an under-utilized “back-up plan” to such harsh state restrictions.
Medication abortion, also called “the abortion pill,” typically involves five separate pills made up of two different medications. One pill (200mg) of mifepristone is taken first, then four pills of misoprostol (200mcg) are taken 12–48 hours later. Misoprostol induces uterine cramping and bleeding, which can be painful, but is extremely effective at safely terminating a pregnancy. Organizations like Aid Access mail abortion pills to people living in US states with abortion restrictions. After the passage of Senate Bill 8 in Texas, Aid Access announced it would also provide “advanced provision” of abortion pills to folks in the United States, meaning someone can be sent the pills in anticipation of a future need. Aid Access functions somewhere in-between telemedicine abortion, where a doctor is involved in the legal prescription of the pills through the internet, and self-managed abortion, where the patient typically sources the pills themselves outside of the medical system. Self-managed abortion does not only occur in response to legal restrictions: many choose to self-manage their abortions to take control over their abortion experience. In the patchwork map of abortion access in the US, self-managed abortion is increasingly visible as a tool to circumvent state restrictions.
In response to new state restrictions, a writer at the Atlantic published a piece arguing that many people in the US do not know about self-managed abortion options, preventing abortion pills from becoming the “back-up plan” that people need. One activist quoted in the article suggests “abortion clinics and [abortion] funds are not sufficiently promoting self-managed abortion…because they fear it will quell the sense of emergency over the war on reproductive rights”. In other words, if activists did fully promote self-managed abortion options, politicians might think protecting legal abortion is somehow less important. Backlash against the article came swiftly from those supporting abortion clinics in Texas. Clinics felt they were being blamed for keeping self-managed abortion a “secret”. Activists in Texas also felt the remarks about self-managed abortion being a panacea to abortion bans did not address concerns about criminalization — both of providers for advocating care outside the medical system and of marginalized people for self-managing their abortions.
I have spent the past six years following similar debates in Ireland, where abortion was legalized by popular vote in 2018. Before the legislative change, thousands of Irish people were self-managing their abortions using medication from Aid Access’s European arm, Women on Web, as well as other illegal and activist-supported avenues. This was a shift away from a pattern that had existed for decades, where those seeking abortion were forced to travel abroad to England. The ability to have an abortion on the island of Ireland was a revolution in the Irish abortion experience — yet pro-choice organizations varied on their approach to promoting this option. During the years leading up to legalization, abortion pills took on multiple, unstable, and even contradictory meaning within the abortion debate. They were simultaneously “very dangerous” — according to some doctors and politicians who wanted to make an argument for legalization based on protecting “women’s health” — and “incredibly safe,” according to activists who made up the networks facilitating illegal access to the pills. Some activists embraced the pills only as the modern-day “coat-hanger,” a symbol of the need for legal change, while most thought it was important to share information on the safety and ease of using abortion pills.
In 2014, Irish activists staged an “abortion pill train,” echoing an action in 1971 where feminists smuggled contraceptives on a train from Belfast to Dublin. They brought abortion pills into Ireland and swallowed the pills in front of the media to show their safety. The train was a deliberate attempt to publicize the use of abortion pills, which had previously been kept hidden and used only as a technology of access for those in dire need. The transformation of this useful drug into what I call a “technology of protest” sparked debates within the pro-choice movement about how to advocate for legal abortion. Many activists facilitating clandestine access to abortion pills were unhappy with other activists making the pills a symbol of protest, potentially endangering access to the pills by bringing the state’s attention to them. The debates over an “abortion pill solution” for Texas echoes these very same concerns about combining access and protest. Local abortion access groups in Texas took issue with the mainly white, middle-class feminist organizations calling publicly for more self-managed abortion in Texas, when they remained unaware of the situation “on the ground” regarding access and criminalization.
These cross-Atlantic echoes do not surprise me. American activists have already been inspired by their Irish counterparts: in December 2021, activists took abortion pills in front of the Supreme Court while protesting Mississippi’s 15-week abortion ban. These resonances point to the importance of taking a transnational and global view of abortion activism — the story of the abortion pill in Ireland should be an instructive tale for activists in the United States. It can show which actions and messages around abortion pills and access might be successful, and which might cause increased controversy.
There is no doubt that abortion pills will be central to the on-going fight for abortion access in the United States — but it is up to activists to strategically manage their influence. Looking at the histories of other movements is one crucial step is realizing abortion pill’s full impact.
