Untapped potential of the abortion pill, 15 years later

In the midst of the constant assault on reproductive rights – such as the recent House vote to defund Planned Parenthood, the Senate vote on an abortion ban at 20 weeks, and yet another looming government shutdown fight over support for reproductive health services — it can be easy to lose sight of how far we’ve come in providing women with more reproductive healthcare options.

However, on Sept. 28 we had the opportunity to pause and celebrate one such advance: the 15th anniversary of the Food and Drug Administration (FDA) approval of Mifeprex (formerly RU-486), the brand name of the drug mifepristone, more commonly known as the “abortion pill.” Typically taken in combination with misoprostol, together the two drugs can be up to 97 percent effective in ending pregnancy without surgical intervention.

{mosads}The approval of mifepristone has given women another safe method to end an early pregnancy, and its use is increasing. Yet, the abortion pill has untapped potential for improving the availability and affordability of abortion and other fertility management techniques in the U.S.

The abortion pill should not be – but often is — confused with the “morning-after pill,” also known as “Plan B” or emergency contraception (EC). While mifepristone induces an abortion, EC is contraception that can be taken when routine contraception (“Plan A”) has failed or was not used. EC cannot interrupt an established pregnancy and simply will not work if one is already pregnant. In other words, EC cannot cause an abortion. Nevertheless, many people often think of the morning-after pill and the abortion pill as one in the same, when they incontrovertibly are not.

The confusion between mifepristone and EC is no coincidence. For decades, opponents of women’s health and rights have pursued a concerted campaign to blur the lines between contraception and abortion in order to stigmatize and undermine access to both. In particular, this intentional obfuscation has been used by some corporations as an excuse to object to covering the full range of FDA-approved contraceptive methods as required by the Affordable Care Act.

While the Reproductive Health Technologies Project (RHTP) will always try to correct the record and make sure people have the facts about all reproductive technologies, I’d like to suggest that progressives actually embrace the confusion in order to flip the script. The main reason for drawing a bright line between abortion and contraception (besides scientific integrity) has been an attempt to keep abortion stigma from “tainting” contraception. But that effort thus far has failed.

For evidence of that proposition, look no further than to the relentless attacks on Planned Parenthood by its detractors, who have used sensationalist claims about abortion in a stealth attempt to dismantle our nation’s family planning network. The lesson should be that, if we want to protect contraception, we must also fight for abortion and against abortion stigma.

Lo and behold, mifepristone could give us a tangible opportunity to do just that. In many parts of the world, women use medication – either mifepristone and misoprostol together or misoprostol alone — for “menstrual regulation” or to “bring down their periods.” In other words, they know they’ve missed a period, they don’t know if they’re pregnant, but they know they don’t want to be (a “Plan C”!).

Regardless of how we categorize it (contraception, abortion, or something in between), in such a scenario a woman has been able to access a safe and effective technology that empowers her to make a decision about whether she wants to be pregnant at that time, in accordance with her own conscience. And that’s what matters.

Instead of continuing what seems to be a futile effort to mark clear distinctions between preventing and ending a pregnancy, let’s welcome the uncertainty. Not that we should allow anti-abortion zealots to continue to peddle their misinformation — we of course want women to be fully informed of their health care options — but there’s an opportunity here in recognizing that women’s lives are not lived in black and white but rather in shades of gray.

And instead of allowing that uncertainty to be an obstacle to care, let’s use it to ensure that women have access to the technologies they need to control their fertility in the ways that work best for them. In the meantime, let’s take a moment to celebrate the options mifepristone has given women over the past 15 years and set on our sights on what we might be able to achieve in the next 15.

Arons is president & CEO of the Reproductive Health Technologies Project.