New Book Outlines Medication Abortion’s Origins—From ‘Chance’ Discovery to Decades of Clinical Tests and Global Approval

The abortion drug mifepristone has transformed abortion care in the U.S. since its approval by the Food and Drug Administration 25 years ago.

When combined with misoprostol, a drug that was originally used to prevent stomach ulcers but that can also trigger uterine contractions, mifepristone makes medication abortions more effective, with fewer side effects. That, in turn, allows people to largely manage their care at home—even in states where abortion is illegal.

Its surge in popularity following the U.S. Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and gutted federal abortion rights, has made it a target of anti-abortion groups. The FDA is planning to “review” mifepristone based on those groups’ trumped-up claim of safety concerns, which could potentially lead to new restrictions on the drug.

Journalist Rebecca Kelliher’s recent book, Just Pills, traces the history of abortion medications, starting with misoprostol’s whispered origins among Brazilian women in the 1980s as a “pill that makes your period back” through decades of clinical trials and widespread use in almost 100 countries.

Rewire News Group spoke with Kelliher about abortion politics, the disinformation that swirls around reproductive rights, and inspiration from abroad.

The following conversation has been lightly edited for length and clarity.

The development of the abortion pill, as you tell it, includes quite a bit of chance: Brazilian women realize that a cheap ulcer medication causes uterine contractions, an American scientist hoping to treat Cushing’s disease discovers that mifepristone blocks progesterone. Does new drug development typically hinge on happenstance or is there something about an abortion pill that required a fair dose of luck?

I think both are true. A lot of science, in general, is trial and error, which is kind of a degree of chance.

But when we’re talking about misoprostol and mifepristone’s development in the ‘70s and ‘80s, we’re talking about a time when the pharmaceutical industry was even more male-dominated than it is today. There was just, at that time, a lot of stigma and also not a good understanding of abortion or much interest in pursuing an abortion medication. So I think there’s a degree of chance that was needed in order to get these medications out in the world. It’s kind of amazing that it even happened.

What restrictions does mifepristone still have, and what restrictions do anti-abortion forces want to impose?

Mifepristone is still under what’s called the REMS, or Risk Evaluation and Mitigation Strategy, a program that the FDA started for medications that it deemed needed more controls … even though it has a very strong and consistent safety profile.

We have so much information about its safety, not just in the United States, but around the world, where mifepristone has been approved now in nearly 100 countries.

What [the anti-abortion movement] is trying to do right now is to put back in place one component of the REMS that the FDA had first removed temporarily in 2021 [during] the COVID-19 pandemic … called an “in-person dispensing requirement,” which meant that … people had to physically go in person to pick-up mifepristone from their provider.

That was first a temporary removal, and then the FDA made that removal permanent in 2023. That really opened the doors to telehealth abortion in the U.S., which has become such a huge lifeline in a post-Dobbs U.S. We just got the latest numbers from the Society of Family Planning, which found that now nearly 30 percent of abortions in the U.S. are provided via telehealth.

And for people who are living in states under abortion bans, if they’re seeking abortion in the formal health-care system, we know that they’re getting abortions through what are called telehealth abortion “shield law” providers, [who are] mailing pills directly to people.

This is infuriating the anti-abortion movement, which is why they want to reinstate the in-person dispensing requirement on mifepristone. If the FDA did that, it would have nationwide consequences.

This is not the first time the U.S. government is trying to restrict mifepristone—but it’s the first iteration post-Dobbs. Does this feel like familiar territory or a new threat?

What’s familiar is the underlying false claim from the anti-abortion movement that mifepristone harms women, which is not true. The anti-abortion movement has been pushing this disinformation about mifepristone since the beginning. There are early congressional hearings that I write about in the book that take place in 1990 and 1991 where … American anti-abortion activists [were] spreading this disinformation.

But the stakes are just so much higher now, because unlike back in the ‘80s and the ‘90s, today we have a post-Dobbs U.S. where huge swaths of the country people are living under abortion bans, and their only route to access might be getting abortion pills through telehealth abortion services.

What would you tell Congress if called to testify about the FDA “review” of mifepristone’s safety?

I would say: If this is an honest, fair review of the evidence of medication abortion, then the restrictions that currently exist on mifepristone should be loosened.

You write in the book that “women in Brazil today have less access to misoprostol than they did three decades ago—and the post-Dobbs U.S. should pay close attention.” What did you mean by that?

Brazil’s restrictions on misoprostol include restrictions on the spread of … information online about misoprostol use for abortions. And that’s an area that I think we really need to pay attention to in the U.S.

I think a lot of this is going to come down … to: Do people know that these pills are safe, that they exist, and that there are ways to get them?

Because if you don’t even have that basic knowledge, then how can you get the care you need or help other people get the care that they need?

(Read more: How to Protect Your Reproductive Health During Trump’s Second Presidency)

Elsewhere in Latin America, reproductive rights are expanding. In recent years, Chile, Argentina, Mexico, and Colombia have all decriminalized or legalized abortion. What could the U.S. could learn from the strategies used in those countries?

I spent quite a bit of time in the book writing about this one network called the Socorristas en Red [Aid Workers’ Network]. They formed in the early 2010s under a near-total abortion ban at that time in Argentina.

They formed because they kept getting calls from people in their community who needed abortion care, and they realized that they actually could safely support people through abortions with pills, specifically with misoprostol. At that time, you could still find [misoprostol] in some pharmacies in Argentina over the counter.

What’s amazing to me about the Socorristas and other “accompaniment” groups like this is these people … were not licensed clinicians. But they did this work very carefully, and they created strategic alliances with feminists in the health-care sector and in the legal sector, all trying to better protect themselves, their network and the people that they were supporting, while still pushing for changes in the law.

And they did succeed, as you mentioned. In late 2020, Argentina did legalize abortion, though only up until about 14 weeks in pregnancy.

What I find inspiring about this for folks in the United States, especially for people who are trying to support those or already are living in states under near-total abortion bans, is it speaks to the importance of community and of keeping each other safe in a moment of serious crisis

What specific examples could you imagine being applied from abroad to a U.S. state with a very stringent ban?

Spreading information is still legal, right? Giving good information about abortion pills and their safety and their efficacy—it’s still protected, as far as I understand, under freedom of speech. That’s a pillar of how networks in Argentina … operated [and it’s] something that people can do here.

The post New Book Outlines Medication Abortion’s Origins—From ‘Chance’ Discovery to Decades of Clinical Tests and Global Approval appeared first on Rewire News Group.