History and Politics of Medication Abortion in the United States and the Rise of Telemedicine and Self-Managed Abortion.

ABSTRACT

This article examines the decades-long campaign to increase access to abortion pills in the United States, including advocates' work to win U.S. Food and Drug Administration approval of mifepristone and misoprostol for abortion, the continuing restrictions on mifepristone and the multiple strategies advocates have pursued to challenge these restrictions, including lobbying the FDA to remove the restrictions, obtaining a limited research exemption from FDA restrictions and suing the FDA during the COVID pandemic. The article pays particular attention to influence of research conducted on the safety and efficacy of medication abortion as well as research on the impact of increased availability of abortion pills through telemedicine during the pandemic. The article also addresses self-managed abortion, where people obtain and use mifepristone and/or misoprostol outside of the formal healthcare system, and documents the growing network of organizations providing logistical, medical and legal support for people self-managing abortion. The article concludes with reflections on the role abortion pills might play in the post-Roe era amid increasingly divergent abortion access trends across different regions of the United States.