By: Sarah Hartley

Prior to and since the recent Dobbs decision, abortion has been a hot topic in American discourse and is a premiere focus in today’s political arena. Discussions promoting or protesting access to safe abortions underlie almost every aspect of life—in the news, the courtroom, even outside of clinics that perform abortions as just one aspect of the services they provide. Regardless of where the discussion is held, however, anti-abortion advocates frequently refer use one tool to further their arguments—pictures of fetal tissue removed during late-term surgical abortions. But the reality is far from the storyline these advocates work so hard to promote.

An analysis conducted by the Guttmacher Institute found that 53% of outpatient abortions were “medication abortions.” By 2022, preliminary data showed that medication abortions made up 54% of outpatient abortions. This means that, for the past several years, more than half of all abortions have consisted of no surgical intervention; further, most abortions involve no surgical removal of fetal tissue—the photos of which are reproduced by anti-abortion advocates and given to people walking in to the few remaining clinics that provide abortion access. So, what exactly is a “medication abortion” and why are they so popularly underdiscussed?

A medication abortion, known as RU-486, can occur through the consumption of two safe and effective medicines: mifepristone and misoprostol. The coupling of these two medications for the purpose of terminated unwanted pregnancies have been FDA approved since 2000, and has a success rate of 99.6%, with the associated risk of mortality being very limited at a risk of 0.00064%. In 2016, the FDA updated the prescription information, approving the drug combination to be used safely up to ten weeks of pregnancy, which still leaves a small window for consumption since most women do not experience physical symptoms of pregnancy until the fifth or sixth week.

Given the safety, efficacy, and increased ability to access the abortion pill provides, as it can be self-administered by the patient, why aren’t medication abortions easier to access? If they were, could the possibility of medication abortions limit the impact of the Dobbs decision on women and individuals with uteruses in states where abortion restrictions have already kicked in?

Unfortunately, neither of those questions have an easy answer. Despite gaining FDA approval in 2000, it took two decades for the medication abortion alternative to become the most common method to ending an unwanted pregnancy at an outpatient clinic. While distribution issues surely played a role, the more likely answer is that medication abortions aren’t discussed, advertised, or commonly known to be an option for ending a pregnancy. This lack of knowledge likely starts at schools in sex education classes. There may be a lack of accuracy surrounding the populations’ views on abortions because only 24 states and D.C. require that sex education be a course in public schools. And in schools that do offer sex education classes, 37 require the inclusion of abstinence, but 26 of those require that abstinence be the main stress. Allowing access to accurate abortion information is vital, and it should be starting in schools, but when that isn’t an option, abortion advocates should be highlighting the importance of medication abortions, and should be promoting them, when possible, within the first ten weeks of an unwanted pregnancy.

But regardless of increasing the access to information, Dobbs throws a wrench in all women’s potential abortion plans—be it medication or surgical. Though the medication has been federally approved for years, state abortion restrictions limit access to medication abortion in the same way as surgical ones. In states where abortion restrictions have yet to be passed, legislatures are crafting ways to prevent the dispensing of abortion pills. In Arizona, for example, a medication abortion can be accessed by an individual seeking to terminate a pregnancy, but it can only be prescribed by a physician at an in-person clinic, creating limitations to access for those who cannot travel or afford to visit a physician who would be willing to write a prescription for RU-486. The option to have a medication abortion by self-administration in one’s own home seems like the best middle-ground option for both sides of the abortion debate. Medication limits the period to ten weeks gestation, meaning that it is kept within the first trimester and prior to advanced levels of fetal development. Further, the pill has been commonly termed as “safer than Tylenol” and presents little risk. Still, availability of the pill rests in the hands of state legislatures, and it seems that it will remain that way so long as we are living in a post-Dobbs society.

Sarah (she/her) graduated from the University of Pittsburgh with a B.S. in Psychology. She is currently a 2L at Arizona State University’s Sandra Day O’Connor College of Law and hopes to eventually work with juveniles being charged as adults. Her legal interests include indigent defense, criminal justice reform, post-conviction relief, and issues affecting the LGBTQ+ community. When not in law school, Sarah enjoys cooking, traveling, and learning new languages.