Tech-ing the Trade: Notes on Reformulating Abortion and Its History.

Abstract

Tech-ing the Trade: Notes on Reformulating Abortion and Its History Kelly O’Donnell (bio) In the introduction to her 2014 treatise Pro: Reclaiming Abortion Rights, feminist author Katha Pollitt confessed that in the face of mounting legal restrictions and the degrading landscape of abortion care in many parts of the country, she found herself daydreaming, there is something, some substance already in common use, that women could drink after sex or at the end of the month, that would keep them unpregnant with no one the wiser. Something you could buy at the supermarket, or maybe several things you could mix together, items so safe and so ordinary they could never be banned, that you could prepare in your own home, that would flush your uterus and leave it pink and shiny and empty without you ever needing to know if you were pregnant or about to be. A brew of Earl Grey, Lapsang Souchong, and ground cardamom, say. Or Coca-Cola with a teaspoon of Nescafé and a dusting of cayenne pepper. Things you might have on your shelves right now, just waiting for some clever person to put them together, some stay-at-home mother with a chemistry degree rattling around her kitchen late at night.1 Such a substance, she claimed, would subvert “the whole elaborate panopticon that governs abortion today.” This was partially the promise, Pollitt observed, of mifepristone, otherwise known as RU-486—but “the French abortion pill” had as yet failed to deliver. Few doctors were prescribing it, the law regulated it just as heavily as surgical abortions, and it was still fairly difficult to obtain.2 The allure of the abortifacient lingered, but no pregnancy-ending panaceas seemed forthcoming. By 2020, only a few years later, the landscape of abortion care in the United States had changed dramatically. Hastened in part due to the COVID-19 pandemic and its many disruptions of routine medical practice, medication abortion suddenly accounted for more than half of all [End Page 57] abortions in the country, jumping from 39 percent in 2013 to 54 percent in 2020 according to Centers for Disease Control and Prevention data (as reported recently by the Guttmacher Institute). Approved for use up to ten weeks of pregnancy, the combined regimen of misoprostol and mifepristone pills, taken sequentially over a series of a few days, is now the procedure of choice for early pregnancy termination.3 That same year, the American College of Obstetricians and Gynecologists (ACOG) issued an updated practice bulletin regarding the use of medication abortion, outlining its safe use for up to seventy days of gestation. The organization found that “patients can safely and effectively” use or administer medication abortion at home, and that “routine in-person follow-up is not necessary after uncomplicated medication abortion.” However, the Food and Drug Administration’s regulatory guidance around one of the drugs—mifepristone—required that it be administered in person, under the guidance of a medical professional. After taking this part of the regimen, patients could then self-manage the procedure at home using the remaining dose. ACOG found this risk and evaluation mitigation strategy (REMS) unnecessary and urged the FDA to remove this requirement in order to broaden access.4 The following year, as pandemic-era telemedicine flourished and the Supreme Court heard Dobbs—a case that was widely expected to challenge if not overthrow core tenets of Roe v. Wade—access to medication abortion was significantly expanded. In December 2021, the FDA moved to permanently allow access to mifepristone by mail.5 As ACOG had suggested, the agency altered its REMS Program for the drug, removing the “in-person dispensing requirement,” thus allowing for greater autonomy in self-management.6 In March, JAMA Internal Medicine reported new data showing that pandemic-era data collections proved that a physical exam was unnecessary prior to prescription of the drug in the overwhelming [End Page 58] majority of situations.7 An editorial in the same issue explicitly called for a new, freer standard in the use of medication abortion, heralding a new consensus emerging among clinicians.8 When the draft of the majority opinion of Dobbs v. Jackson Women’s Health Organization...