A teenager whose mother had trouble getting her to an abortion clinic during normal business hours.
A busy professional who couldn't leave work until 4 p.m.
A mother with young children, no child care and no car.
All of these Maine women recently had abortions in the privacy of their own homes, without having to step foot in an abortion clinic. Using pills that arrived by mail as part of a study by the research and technical assistance organization Gynuity, the women legally induced their own miscarriages before 10 weeks of pregnancy. And in doing so, they became soldiers on the front lines of the biggest abortion battle you've never heard of.
Hailed in the 1990s as "the pill that changes everything," the abortion pill mifepristone (also known as RU-486 and Mifeprex) got off to a slow start after Food and Drug Administration approval in 2000.
But now, the pill is at a crossroads, with 31 percent of American abortion patients choosing pill-induced abortion over surgery, and bold new initiatives dangling the prospect of dramatically increased access. The Gynuity study is allowing women in Maine, Hawaii, Washington, and Oregon to confer with a doctor from home via video chat, and then get the pills delivered to their homes by mail. In California, women may soon be offered an even more streamlined medication-by-mail option. In Hawaii, the American Civil Liberties Union recently filed a lawsuit that could open the door to ordinary doctors nationwide prescribing the pill, and women picking it up at their local pharmacies.
"I feel optimistic," said Francine Coeytaux, co-director of Plan C, an abortion-rights project that hopes to offer pills by mail in California soon via a demonstration study, and then expand to other states as well. Plan C offers a website with information about pill-based abortion and anticipates that established international telemedicine-abortion initiatives, such as Women on Web, will find a way to ship pills to women in the U.S.
"It's not about what we're doing. It's a fact. It's happening. It has so much potential, and there are so many ways in which it's beginning to happen, that nobody's going to be able to stop this," Coeytaux said.
Anti-abortion forces are concerned, and they hold the upper hand politically. With a Republican president and Congress and control of 31 state legislatures, they see multiple ways to block the pill, including a U.S. Supreme Court reversal of Roe v. Wade.
The pill is a "big priority," according to Carol Tobias, president of the National Right to Life Committee. Since 2011, 20 states have banned the use of telemedicine for pill-based abortion. In Iowa, the state Supreme Court later struck down the ban.