Self-managed abortion is the future of abortion access; neither courts nor legislatures can fully block it.
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In July, as this country lurched in fits and starts to address the COVID-19 pandemic that had by then already claimed nearly 150,000 lives, a new possibility for abortion access bubbled up in a Maryland court. U.S. District Judge Theodore Chuang took the first step in deregulating abortion pills.

In response to a request from abortion providers and reproductive justice advocates, Judge Chuang ruled that the Trump administration could not enforce a restriction that prevents patients from accessing medication abortion without an in-person doctor’s visit, finding the requirement unduly burdened abortion rights in the middle of a pandemic.

The decision sent immediate shockwaves across the abortion rights landscape.

Abortion rights advocates, who had spent the last 20 years arguing medication abortion was exceptionally safe and overregulated, applauded the decision as a commonsense approach to abortion care generally, let alone in a pandemic. Activists in the 19 states where anti-choice lawmakers had years earlier banned the use of telehealth for medication abortion were quick to point out that Chuang’s decision would do nothing to ease the crisis of access in their states. And because of the unique place abortion rights hold in this country’s political landscape, both camps were correct.

The decision promised to change both everything and nothing, at all once.

Mifepristone was first developed in France in 1980, but it took two over two decades and at least one trip to the Supreme Court to even get it approved for use in abortions in this country. Under George H.W. Bush’s presidency, the Food and Drug Administration first banned importing mifepristone to this country for use in abortions. Once it was finally approved, anti-choice advocates in Washington, D.C., layered regulatory burden after regulatory burden on use of the pills. Anti-choice lawmakers in states across the country followed up by banning the use of telemedicine to distribute the pills.

Anti-choice advocates have fought so hard against the abortion pill because they know it’s a game changer.

As if to underscore just how much the anti-choice forces understand what’s at stake in the fight over regulating abortion medications, the Trump administration appealed Judge Chuang’s decision to the Supreme Court not once, but twice. In January the conservative justices on the Court voted to reinstate the in-person requirements. The Biden-Harris administration could lift them again. But meanwhile states like Ohio have doubled down on efforts to restrict access to medication abortion, showing that even as this country faces nearly 500,000 COVID-19 deaths, anti-choice conservatives will prioritize attacking abortion access over literally anything else. This has left patients in an increasingly untenable ping-pong match. Abortion remains legal in this country but increasingly out of reach and defined by the happenstance of a ZIP code.

In the backdrop of this legal and legislative fight over medication abortion, a new future for abortion care is taking hold, one in which patients increasingly manage their abortions entirely on their own. To be clear, abortion via herbs has existed as long as people were able to get pregnant. And even a medication abortion done with physician supervision involves the patient managing some aspects of that abortion on their own. But as the legal and political threats to abortion care reach a fevered pitch in this country, more and more people are choosing to terminate pregnancies on their own, without the supervision of a medical professional. The COVID-19 pandemic only accelerated this reality.

Self-managed abortion is the future of abortion access; neither courts nor legislatures can fully block it. Patients are taking care into their own hands.

That future is not without legal risk, though. While only five states have laws that explicitly make it a crime to self-terminate a pregnancy, that hasn’t stopped some prosecutors from trying to use other statutes—like child endangerment and fetal harm law— to jail patients for ending their own pregnancies. Predictably, it is patients of color and low-income patients, who already face heightened surveillance and scrutiny by both health-care providers and law enforcement, bearing the brunt of those prosecutions. Medically, self-terminating a pregnancy via pills remains extremely safe. The legal risks, however, are potentially much greater.

That’s why, for our first special edition of 2021, Rewire News Group is diving into medication abortion and self-managed care as the future of abortion access. From COVID-19 to the courts, the legal right to abortion has never been more tenuous. But thanks to the internet and the ingenuity of advocates, abortion pills have never been easier to access.

Abortion is good medicine, and self-managed abortion is the future of access in what’s shaping up to be a post-Roe world.