Since it became clear that deer is likely to fall in the coming weeks, activists and those generally interested in preserving access to abortion have heralded medical abortion as the big solution to ending legal abortion. And it’s true, mifepristone and misoprostol have a lot of benefits that will surely come in handy in our post-deer the future, the main one being that it is a safe and effective do-it-yourself, at-home method of abortion.
As Kimberly Inez McGuire, Executive Director of URGE (Unite for Reproductive and Gender Equity), said at a press conference: Along with low-income communities, immigrants and trans youth, it is even more important that we see the potential of self-managed abortion as an essential tool for accessing reproductive health care and empowerment for these marginalized communities.
Although there are other types of self-managed abortions, the primary approach to abortion care for these communities is the abortion pill, according to McGuire and Abortion on Our Own Terms, a campaign she works with that aims to educate pregnant women about their options. McGuire and his colleagues understand that education is an important part of their campaign, especially regarding the safety of mifepristone and misoprostol use. “The biggest misinformation we see out there is the idea that the loss of Roe vs. Wade will lead to unsafe abortion, and it is very much rooted in this kind of pre-deer [history] it’s really a different experience of abortion, than what that political context was like in the past,” she says. “First and foremost, it is important that we recognize that we have safe and effective abortion drugs that we can use today to self-manage our own abortions.”
However, despite even the best of intentions, medical abortion is not a magic bullet. More precisely, it is not and will not be the solution for everyone. And the sooner we realize this, the sooner we can get to work on desperately needed solutions.
I’m writing this looking at my “AVORTION PILLS FOREVER” poster, courtesy of Shout Your Abortion. But over the past two years, I have asked activists: what about the people I know who have never been able to access medicine?
There are the rural people who don’t have reliable high-speed internet access and who have endured heaps of misinformation and stigma about their bodies and genders for as long as they’ve been aware of the world around them. Estimates for the number of Americans living in internet deserts vary, but they’re all significant: the FCC says it’s somewhere around 14.5 million; the White House has it at 30 million; and BroadbandNow, a research group, says the FCC severely underestimates the number, putting it instead at around 42 million.
Then there are countless people who just can’t risk getting caught – perhaps a teenager or someone with an abusive partner, not to mention anyone fearful of prosecution in a rapidly changing legal environment. and eager to target abortion pills. Basically, the leaked draft Supreme Court opinion regarding Dobbs v. Jackson Women’s Health Organization reverses the standard of confidentiality established in 1973 Roe vs. Wade decision. “This is a particularly powerful change in the digital age, which raises pressing questions about data security and privacy. The tools so many of us rely on to engage in the modern world are largely traceable, making it easier for authorities (or even individuals) to prosecute people seeking abortions or those trying to help them,” writes Erica Hellerstein for .coda. “People’s search histories, text messages, location data, social media activity, purchase records and use of reproductive health phone apps will likely become standard evidence in court cases against people seeking an abortion.”
To that end, people of color, who are disproportionately prosecuted unfairly under a criminal justice system that targets them primarily for their blackness, may understandably hesitate before attempting to illegally, or even legally, acquire abortion pills. We have already seen black people giving birth sued at a much higher rate for their pregnancy outcomes. In a study by the National Advocates for Pregnant Women, which analyzed 413 cases from 1973 to 2005 in which a pregnant person was arrested, detained or subject to legal intervention related to their pregnancy, 59% of these cases involved women of color. (including, depending on the study categories, African Americans, Hispanic Americans/Latinas, Native Americans, and Asians/Pacific Islanders). Fifty-two percent of them were African American. In the Southeast, where there has always been a concentration of such cases, the numbers are even more dire; nearly three-quarters of the cases brought against black women took place in the South.
Oriaku Njoku, co-founder of Access Reproductive Care (ARC) Southeast, says telling people to just go online, pay over $250, and wait for the pills to come in the mail doesn’t match the experiences experiences and circumstances of most people. “They don’t think about how black and brown bodies are systematically criminalized,” she says. (Njoku uses the pronouns she/they.)
They also don’t think about how often the physical ailments of black bodies are also ignored. Njoku experienced it firsthand: growing up in Kentucky as a Nigerian immigrant and enduring heavy and painful times that were repeatedly dismissed by local doctors. It wasn’t until she moved to Atlanta at age 36 and found a black OB-GYN that she was finally diagnosed with polycystic ovary syndrome. The Njoku experience is just one example of the endless disparities that exist between rural populations and those living in metropolitan areas, between black bodies with wombs and white bodies with wombs, which could have a impact on the accessibility of abortive drugs.
The truth is that a one-size-fits-all solution for abortion access simply does not exist because of the deep and enduring inequalities that exist in this country. Njoku points out that too often people co-opt the mission of reproductive justice without truly committing to it and without considering structural inequalities, such as what self-managed abortion will look like when abortion is no longer a constitutional right. “We need to find a way to have the conversation without whitewashing or watering down the message, because that’s completely opposite to the original intentions of the reproductive justice founding mothers,” Njoku says. “Access is not the same in all areas.”
The Plan C team also discussed ways to recognize and address these gaps. The national organization, which works to help people who want to self-manage their abortions get mifepristone and misoprostol, has publicized their service, which comes with legal support, as well as phone and text support. They paid for ads that topped Google searches and appeared in the social media feeds of anyone who searched for abortion resources online. Perhaps most importantly, they’ve partnered with local abortion funds and reproductive justice organizations, hoping to position themselves as a resource that community leaders can tap into. “We advocate for all options to be available, we advocate for someone to understand the range of options so they can make the decision that’s best for them,” says Amy Merrill, co-founder and chief digital officer of Plan C. for continue to be a place for local clinics that are still finding creative ways to serve, there will be a place for abortion funds to help people… it’s going to be a patchwork of resources and as needs are met in all kinds in different ways.” As more and more legal barriers to care likely continue to emerge, such as a ban on receiving abortion pills in the mail, this patchwork will be even more needed.
Even in a post-deer America, the only way to truly meet people where they are with the care they need is through community organization. ARC Southeast and Indigenous Women Rising (IWR) and other peer organizations work to fund abortion and educate traditionally marginalized communities about sex.
The communities most affected by the loss of access to federally protected abortion must be at the center of discussions about solutions, says Rachael Lorenzo, Executive Director of the IWR. (Lorenzo uses the pronouns they/them.) Empowering people with knowledge is a crucial part of this work. “We are trying to build our organization to incorporate abolitionist values into our practice, and the concept of Land Back and the importance of our connection to the land, as Indigenous people, as original stewards of the land, and how it plays into our reproductive health,” they say. “That means educating our loved ones about forced sterilization, about spotting clues of potential coercion around contraception,” for example.
It’s hard to imagine the community that Lorenzo describes as having the resources, basically, to order pills and self-manage their abortions, on top of the stigma and historical hurt they already endure. “There’s a lot of generational trauma and PTSD from our elders, and they may not know how to talk about sex, consent, and normal bodily functions with the young people in their lives,” Lorenzo says. In the future, the IWR hopes to expand its services, including, for example, midwives. “Part of what we do is make sure we create space for them to use their own words, their own tradition, culture and oral history so they can connect with the people in their lives about sexual health.”
All of this is not to say that medical abortion shouldn’t be an option for everyone, rather that it can’t be the only option.