大象传媒

When 18-year-old Rachel discovered she was unexpectedly pregnant, she made what she thought was a natural first step: call Planned Parenthood to schedule an abortion. 鈥淚 wasn鈥檛 ready to be a parent or a mom,鈥� she says. 鈥淎nd I didn鈥檛 want to go through giving birth just to give the kid away.鈥� Even in an abortion-friendly state like , the nearest Planned Parenthood was one hour away, and there wasn鈥檛 an available appointment for another month. 

When Rachel consulted ob-gyns, they either told her they wouldn鈥檛 provide an abortion or declined to provide recommendations. And since her insurance doesn鈥檛 cover abortion care, she鈥檇 have to pay the expensive fee out of pocket. 鈥淚 just wanted it to be over with,鈥� she says.

Feeling judged and scared, she and her mom turned to the internet, where they found a virtual abortion clinic. From there, the process was quick and straightforward: Rachel answered some screening questions to ensure she was a good candidate for medication abortion, chatted with a provider, and within days, the pills鈥攎ifepristone and misoprostol鈥攚ere delivered to her door. Now, Rachel says she would choose telehealth again if she were in need of an abortion. 鈥淚 liked that it was discreet and it was cheaper than other options.鈥� 

To be sure, many people are not as lucky as Rachel, a pseudonym we鈥檙e using to protect her identity. Even before Roe v. Wade was overturned in 2022, abortion deserts鈥攄efined as cities or towns located more than 100 miles from an abortion facility鈥攃overed large swaths of the United States, while many states had already instituted burdensome gestation restrictions and mandated waiting periods. was also being used to keep some of the most financially precarious communities from accessing abortion care.

In the two years since Dobbs v. Jackson Women鈥檚 Health Organization, abortion access has become even graver; near or total abortion bans, rendering entire regions of the country abortion deserts. But, despite the fear and shame that tends to cloud the subject, seeking abortion care should be as easy as securing any other telehealth prescription: a few clicks, messages exchanged, and then picking up the mail. 

In December 2021, the U.S. Food and Drug Administration , while professional organizations, including the American College of Obstetricians and Gynecologists, endorsed a telehealth abortion model. These legislative and organizational changes, coupled with , have revolutionized abortion care in the U.S.

It鈥檚 important to note that telehealth is not for everyone and some abortion patients want or need to go to a clinic. So, while avoiding the clinics is empowering for some, we all deserve access to care that works best for us. 

Finding Freedom in Virtual Clinics

While the future of mifepristone access in the U.S. depends on a , easy, convenient, and compassionate in-home abortion care continues to be an option for many. It鈥檚 still legal to access virtual clinics in 24 states and Washington, D.C., and now are happening through these clinics. The latest science from at the University of California, San Francisco, a research group I am affiliated with, shows that abortion via telehealth is . In fact, medication abortion overall is regarded as safer than many common medications including .

In response to the 2022 Supreme Court ruling, some states began passing proactive abortion protections, making abortion care in those states more accessible. Six states have begun passing , which allow health care providers to send pills to patients across state lines, while some people are even securing these pills on their own through what鈥檚 referred to as a 鈥渟elf-managed abortion.鈥� 

Research I鈥檝e worked on regarding self-managed abortion indicates that many people inaccurately believe it to be unsafe across the board (e.g., they think of 鈥渃oat hanger鈥� abortions). In actuality, even the World Health Organization recognizes medication abortion without doctors to be .

Even the World Health Organization recognizes medication abortion without doctors to be safe and effective.

, when grassroots feminist activists in Brazil discovered that misoprostol, initially developed and prescribed as an ulcer medication, has abortifacient properties. This discovery led to the creation of whisper networks and 鈥溾�� groups, which have since spread throughout Latin America. The groups are now equipped with online tools like WhatsApp to and provide emotional support. 

After decades of protests led by these feminist movements, several predominantly Catholic Latin American countries鈥�, , and 鈥攄ecriminalized abortion. While many pregnant people in these countries can now enter local abortion clinics for the first time, pregnant people in the U.S., some of whom can no longer access clinics, are now reclaiming abortion freedom from the comfort of their homes.

The most recent data indicates that around have attempted a self-managed abortion, which is likely an underestimation. And in with abortion pills, 96.4% successfully completed their abortion without needing an additional procedure and only 1% experienced a medical emergency.

Dana Johnson, Ph.D., an abortion researcher at , is tracking this trend in the U.S. She鈥檚 particularly excited about the emergence of 鈥渁dvance provision鈥� in abortion care, where people can order 鈥渏ust in case鈥� abortion pills online before they鈥檙e even pregnant.

While there are various websites offering abortion pills, , run by Dutch physician Rebecca Gomperts, is one of the most recognizable names in the game. AidAccess ships advance-provision abortion pills across the U.S., even to states with active abortion bans, which Johnson says helps reduce the anxiety for those fearful of a hypothetical pregnancy: 鈥淭hey won鈥檛 have to wait for shipping times,鈥� she says. 鈥淭hey don鈥檛 have to worry about someone intercepting the mail. They can tailor it to their lives.鈥澛�

Johnson and her at the University of Texas, Austin, which has surveyed people across the U.S., have found that a lot of the people who order pills in advance are folks with health issues for whom a pregnancy could be dangerous and even deadly. They鈥檙e right to be worried, as story after story has emerged about pregnant people being unable to receive abortions even in the face of .  

Some people, Johnson notes, are even ordering these pills so that they might be able to help someone else with an unwanted pregnancy. 鈥淭hey were really proud to share medications with the people in their networks. They definitely viewed themselves as activists,鈥� Johnson says. 鈥淎nd a lot of these people who we spoke to weren鈥檛 necessarily activists before.鈥� 

Politicians can close down abortion clinics and pass increasingly draconian bills, but at the end of the day, ( believe abortion should be legal in at least some circumstances). If anything, research such as Johnson鈥檚 shows that people are more engaged and knowledgeable on abortion than ever before. 

Abortion in the Medicine Cabinet

In a country with abysmally high , particularly for Black people, and where , having abortion pills in the medicine cabinet is a prudent safety precaution. Johnson recalls one interviewee telling her, 鈥溾�榊ou wouldn鈥檛 live in a house that didn鈥檛 have a fire extinguisher,鈥� and that鈥檚 why she bought the pills.鈥� Another respondent compared it to traveling with an EpiPen. Perspectives like these offer a new way of thinking about abortion: Rather than treating it as a scary, shameful experience, abortion pills can simply be a part of one鈥檚 health care arsenal, tucked on the shelf between Tums and Advil.

Rather than treating it as a scary, shameful experience, abortion pills can simply be a part of one鈥檚 health care arsenal, tucked on the shelf between Tums and Advil.

Other parts of the health industry that were historically considered radical or fringe have also become part and parcel of health care with widely expanded access. Consider mental health, for instance鈥攁n area of health care long , with a history of criminalizing patients or relegating them to . Now, thanks to the , insurance companies must cover mental health care, and it鈥檚 possible to use telehealth to see a therapist and/or a psychiatrist.聽

Getting antidepressants or antipsychotics today can be as simple as seeing a doctor on video and picking up the medicine. You can even keep anti-anxiety pills on hand in case of a panic attack. Why should abortion pills be any different? 

While sexual and reproductive health care are often deemed the most sensitive or controversial aspects of health care, other medicines within this realm have been mostly destigmatized in order to increase access. For starters, people who are concerned about HIV can now take (pre-exposure prophylaxis), a precautionary pill that lessens the chances of contracting the illness, or PEP (post-exposure prophylaxis) after a potential encounter. 

There are also virtual clinics for HIV/AIDS prevention, including , which also provides contraception, mental health care, and herpes treatment. Even Plan B, which is closer to the cultural land mine of abortion than other medications, is now available over the counter. Doctors can prescribe the medication to patients who want to have it on hand just in case, rather than needing to jump through hoops for access in a moment of crisis. 

Bringing Back Your Period 

, which refer to a regimen of mifepristone and misoprostol used in a different way, might be the final frontier in the transformation of our understanding of abortion. Imagine this: Your period is a few days late and you鈥檙e worried you might accidentally be pregnant. Some, like Rachel, would take a pregnancy test and schedule an abortion. However, for those who don鈥檛 want to have an abortion or don鈥檛 have access to the procedure, these pills can simply 鈥渂ring your period back.鈥� You鈥檒l never have to know whether you were pregnant or whether your period was simply late for other reasons. 

Wendy Sheldon, Ph.D., the lead scientist on , found that interest in period pills in the U.S. 鈥渃ould be substantial.鈥� During her study, which included nearly 700 people across nine clinics, she and her team found that 70% of patients who didn鈥檛 want to be pregnant said they were interested in taking period pills without a pregnancy test. 鈥淚t was enormous,鈥� Sheldon says. Indeed, she and her team were surprised to find no difference in the levels of interest between blue and red states, indicating that even people living in states where abortion access is protected would be interested in period pills. 

Then why have most people never heard of them? While period pills are technically legal across the country, they are caught in the ideological crosshairs of the abortion debates. On one end, groups who seek to ban or highly restrict abortion view period pills as indistinguishable from abortion鈥攖hese days, anti-abortion groups argue that more and more parts of reproductive health care, like or , should be considered abortion. On the other end of the ideological spectrum, abortion-rights groups view period pills as reinforcing abortion stigma, and that empowering people to circumvent a pregnancy test and an abortion contradicts the talking point that abortion is a normal part of health care. 

Additionally, while period pills have been embraced in countries with poor abortion access around the world (from to ), physicians in the U.S. are skeptical. Some, Sheldon notes, are unwilling to prescribe abortion pills in what鈥檚 currently considered 鈥渙ff label,鈥� meaning, these pills are only officially approved to be used after a positive pregnancy test. 鈥淚 think everyone knows that it鈥檚 safe,鈥� Sheldon says, before adding the caveat, 鈥淲e don鈥檛 have enough data yet to publicly convince clinicians.鈥� But in order to get this data, researchers and clinics need funding. Sheldon, for one, was working on a newer study testing the efficacy of period pills but ran out of funding and had to shutter the research. 

Ushma Upadhyay, Ph.D., is a researcher currently leading the first clinical trial on , but recruiting clinics and participants for the study has been difficult. 鈥淭he main obstacle to recruiting people into the study is that people just don鈥檛 know it鈥檚 a thing,鈥� she says. 鈥淚t鈥檚 not mainstream yet. It hasn鈥檛 been accepted.鈥� Despite the difficulties, the research must go on. Upadhyay envisions a future in which people鈥攑roviders and patients alike鈥斺�渆mbrace the unknown鈥� as well as the complexity of pregnancy and abortion. 

If we, as a society, can embrace this complexity, we can forge into this new phase of abortion freedom, where it is so normalized that patients can chat with a primary care provider or even urgent care and pick up misoprostol at a nearby pharmacy without worrying about being shamed, let alone arrested. 

Across these various cases, one thing remains clear: While abortion is more restricted than ever before, freedom also abounds. Amid horror story after horror story鈥攅specially for those whose pregnancy requires in-clinic care鈥攖here are also people taking back their bodily autonomy. Abortion pills keep us safe in the face of bans, whether we order them on an app, keep them on hand, or use them in novel ways. While politicians seek to squash this idea, abortion should remain easy, convenient, and stress-free鈥攁nd we, regardless of what happens at the Supreme Court this summer, have the power to help our communities ourselves.