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Opinion: This Abortion Pill Could Soon Be Hard to Get

A ruling is expected soon in Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration that could revoke the F.D.A.’s 23-year-old approval of mifepristone, one of two drugs typically used for medication abortion.

Misoprostol, the other drug often used in medication abortion, has not come under the same scrutiny. Decades of evidence suggests that misoprostol used without mifepristone is a safe and effective medication abortion option. Misoprostol is also a lower cost medication (compared to mifepristone) and is stocked in pharmacies throughout the US.

Recently, Project SANA published the first U.S.-based study on the safety of misoprostol alone used for self-managed abortion, finding that overall 88 percent of users had a complete abortion, and very few people experienced adverse events or symptoms of a potential complication.

These findings are important given the implications of this court case, but they are also important for expanding access to medication abortion in a variety of settings.

In the wake of the implementation of Senate Bill 8 in Texas on September 1, 2021, Project SANA has been featured in the news focusing on the intersection of the bill and self-managed abortion in Texas.

“Self-management, as we historically thought about it, was very much this idea of a desperate last resort, a very unsafe measure, where you think about coat hangers or drinking household cleaning products,” Dr. Abigail Aiken, lead investigator of Project SANA, says for the Texas Tribune. “We’ve come a really long way since then. Now, when we talk about self-management — not to say those things couldn’t ever happen — but we’re more commonly talking about abortion pills … available from online telemedicine sites and online pharmacies.”

The Washington Post features Project SANA in a recent article on the possible rise of the use of abortion pills in Texas due to increased restrictions. Aiken says that Aid Access operates in a “gray area on the part of people who run the service, but for people in Texas, there’s nothing in our state law that they’re breaking.” Still, she notes that there are legal risks.

A recent NBC News article also references Project SANA studies on self-managed abortion during the March 2020 executive order in Texas, noting that requests to Aid Access almost doubled.

For Rolling Stone, Aiken comments on Project SANA research and abortion access during the executive order: “When clinical care was out of reach, the need for abortion didn’t disappear. People needed to find other solutions, and they did.” 

Read more in Ms. Magazine, The New York Times, The Wall Street Journal, the El Paso Matters feature on the Texas border, Houston Chronicle, Texas Tribune, El Paso Matters, the Austin American-Statesman, Dallas Morning News and KXAN.

Project SANA researcher Dana Johnson has received a grant from the Society of Family Planning entitled, “A misoprostol-alone self-managed medication abortion regimen: An opportunity to democratize self-management in the US?” The project seeks to address the question, “How can we increase access to self-managed medication abortion among populations who face financial barriers to care?”

“This grant will allow us to focus on issues of telemedicine and self-managed abortion, an increasingly important topic given recent abortion restrictions. Understanding more about the misoprostol-alone medication abortion regimen and cost barriers can further democratize self-managed abortion.”
-Dana Johnson