At a time when the pool of abortion providers is shrinking and abortion clinics are closing, medical abortion can truly increase women's access, particularly to those in underserved areas. For legislators who want to end access to abortion under any circumstances, medical abortion is an obvious target. We've seen in the past year a growth in efforts to specifically restrict medical abortion and target abortion providers. Oklahoma, North Dakota and Missouri have all passed laws (some blocked by injunction currently) that either restrict or ban medical abortion altogether.
Medical abortion is a noninvasive termination in early pregnancy. In consultation with a physician, women take the first dose of pills at a health facility and then if a second dose is needed, they can take the pills at home or in another safe and private place and return to the clinic for a follow-up visit.
Under the guise of protecting women, anti-choice legislators are framing medical abortion as a radical, dangerous procedure rather than one that has been safely used by millions of women in Europe, where it was approved in 1984, as well as in Latin America. In Ethiopia, a largely rural and poor country, just three years after introduction of medical abortion, Ipas staff report that roughly 60 percent of women seeking abortion choose medical abortion over other methods in the sites where it is available. In fact, where Ipas works in Nepal and Ethiopia, the governments are working to make medical abortion more widely available to women in remote and rural areas in an attempt to curb maternal deaths from unsafe abortion.
In the United States, we're taking a different course -- denying American women the right to scientific progress and the right to control their own fertility. Anti-abortion activists and legislators have succeeded in stigmatizing abortion and isolating the procedure itself from mainstream medicine. Almost all medical students have to go outside the standard curriculum to learn how to provide abortions -- if they can get the training at all. On top of the now-shrinking pool of abortion providers, anti-abortion legislators have introduced restriction after restriction in the states -- 83 passed in 2011 and roughly 500 restrictions have been proposed since the beginning of this year. For those practitioners who do manage to provide abortions, they're not only harassed, they now have to jump through any number of unjustified hoops to actually help women.
The new law in Wisconsin requires that a doctor be present during the entire medical abortion process, observing the woman as she swallows each and every pill. The new regulations also prohibit doctors from seeing patients by webcam, thus removing medical abortion as an option for women living in areas where there is no abortion provider. If abortion providers don't follow the new rules, they could end up in jail for roughly three years and be fined $10,000 -- or both.
Medical abortion is already heavily regulated in the United States, though we at Ipas know that this simple procedure has prevented women from being injured or killed as a result of unsafe, back-alley abortions.
In Brazil, women realized the potential of medical abortion and widely used the pills to end unintended pregnancies. Brazilian officials could have recognized, as women's rights activists did, that women were desperate to end unwanted pregnancies and were willing to risk their life and health to do so. But they did not. They could have felt empathy for these women and supported their desire for reproductive autonomy by providing access to safe abortion care including contraception. But they did not. Instead, government officials, fueled by Catholic conservatives, banned the drugs entirely. What was the impact? Roughly 1.3 million abortions still occur every year (more or less the same as in the United States), most of them are unsafe, and 250,000 women are hospitalized every year as a result.
Is this where the United States is headed? The first step to banning the drugs in this country is to ban clinicians from prescribing them according to established protocol or by doing exactly what Wisconsin lawmakers have done: making it so hard for them that they stop on their own. In Brazil, there's now an illicit black market for the pills, rather than a safe, supported procedure.
Make no mistake: the ultimate goal of anti-choice advocates is to completely ban abortion in the United States, one step at a time. Having been successful in creating onerous barriers to abortion -- technically still a legal procedure in the United States -- at the state level, anti-abortion activists continue their assault. Now they're creating regulations targeting abortion providers, effectively turning them into criminals for providing a lifesaving service to women.
Ipas is a global nongovernmental organization dedicated to ending preventable deaths and disabilities from unsafe abortion.