The History of Abortion Law in the United States

By Carrie N. Baker | September 14, 2020

Special thanks to Marlene Gerber Fried, Laura Kaplan and Susan Yanow

People around the world have used abortion to control their reproduction at every point in history, and in every known society — regardless of its legality.

In the United States, abortion was originally legal before quickening, the point at which a pregnant person feels  the fetus move, generally at around four or five months. Abortion was widely practiced, primarily done using herbs with the assistance of midwives and other female healers. Some of the earliest anti-abortion laws were poison control measures, passed in the mid-19th century in response to the proliferation of chemical abortifacents that became popular at the time. But by the late 19th century, most states had laws banning abortion except to save the life or health of a pregnant person.

The move to ban abortions occurred for a variety reasons. First, it was part of a backlash against the growing women’s rights movement, which advocated for “voluntary motherhood.” Even though the movement did not support abortion, the demand for birth control was a threat to male dominance. Restricting abortion was part of an effort to control women and confine them to a traditional childbearing role. It was also a way for men in the newly-established medical profession to wrest control over the highly-profitable business of childbirth from midwives, whom they condemned for performing abortions. 

The attacks on abortion access were rooted in racism and white supremacy. White doctors often targeted Black midwives for particular condemnation. People seeking to criminalize abortion were also motivated by increased immigration, specifically of Catholic immigrants, and the declining birthrate among U.S.-born white Protestant women in the late 1800s. The U.S. government and the eugenics movement were concerned about “race suicide” and wanted white Protestant women to have more children.

Despite the legal prohibitions, people continued to have abortions, although surreptitiously. They were subjected to fear and shame, which took a heavy toll on their lives, their health, and their families. While there were providers who practiced safely, finding one often depended upon a woman’s economic situation, her race, and where she lived. Women with money could sometimes leave the country or find a physician who would perform the procedure for a high fee. Poor women and women of color suffered disproportionately. For the most part, they were either at the mercy of incompetent practitioners with questionable motives, unable to find anyone who would perform the procedure, or forced to resort to dangerous self-abortions. In desperation, they inserted knitting needles or coat hangers into their vaginas and uteruses, douched with solutions such as lye, or swallowed strong drugs or chemicals.

Because many deaths were not officially attributed to unsafe, illegal abortion, it’s impossible to know the exact number of lives lost. However, thousands of women a year were treated for health complications due to botched, unsanitary, or self-induced abortions, and many died. Others were left infertile or with chronic illness and pain. Cook County Hospital, Chicago’s public hospital, had a whole ward for women suffering from complications of illegal abortions.  That ward was often full.

MAKING ILLEGAL ABORTION SAFER

Wherever abortion is illegal, caring and dedicated people take enormous risks to provide safe abortions clandestinely, to treat people with complications, and to help them find safe providers.

Before the Supreme Court’s landmark Roe v. Wade decision that legalized abortion in 1973, some well-trained physicians and other medical practitioners risked imprisonment, fines, and loss of their medical licenses to provide abortions. Information about these services often spread by word of mouth.

In the late 1960s, the Clergy Consultation Service on Abortion — a network of concerned pastors and rabbis — set up referral services to help women find safer illegal abortions. Early second wave feminist groups formed their own independent referral groups. In Chicago, a group of trained laywomen called the Abortion Counseling Service of the Chicago Women’s Liberation Union went even further, creating an underground feminist abortion service in 1969. The group, whose code name was Jane, provided safe, inexpensive, and supportive illegal abortions. Over a four-year period, the group provided more than 11,000 first- and second-trimester abortions with a safety record comparable to that of today’s legal medical facilities.

Laura Kaplan, a former Jane member and the author of “The Story of Jane: The Legendary Underground Feminist Abortion Service,” describes the women involved:

We were ordinary women who, working together, accomplished something extraordinary. Our actions, which we saw as potentially transforming for other women, changed us, too. By taking responsibility, we became responsible. Most of us grew stronger, more self-assured, confident in our own abilities. In picking up the tools of our own liberation, in our case medical instruments, we broke a powerful taboo. That act was terrifying, but it was also exhilarating. We ourselves felt exactly the same powerfulness that we wanted other women to feel.

ORGANIZING TO CHANGE THE LAW

In the 1960s, inspired by the civil rights and antiwar movements, women organized a women’s liberation movement. Reproductive rights were a big priority. Advocates fought, marched, and lobbied to make abortion safe and legal. At speak-outs, women talked publicly for the first time about their illegal abortion experiences, making visible the millions of people who were willing to break the law and risk their lives to obtain an abortion, or help someone else do so. The movement also connected abortion rights to gender equality.

Between 1967 and 1973, 14 states reformed and four states repealed restrictive abortion laws. Changes included allowing access to abortion in certain circumstances, such as when the pregnancy was the result of rape or incest. In 1970, New York became the first state to legalize abortion on demand through the 24th week of pregnancy. Hawaii had earlier legalized abortion through 20 weeks, but only for residents of that state, while Washington DC also allowed abortions. Two other states, Alaska and Washington, followed, and women who could afford it began flocking to the places where abortions were legal. Feminist networks offered support, loans, and referrals and fought to keep prices down. But for every person who managed to get to New York or the few other places where abortion was legal, many others with limited financial resources or mobility still sought illegal abortions.

On January 22, 1973, the U.S. Supreme Court struck down all existing criminal abortion laws in the landmark Roe v. Wade decision. The Court ruled that people have a fundamental “right of privacy … founded in the Fourteenth Amendment’s concept of personal liberty.” The Court weighed the pregnant person’s right to privacy against the state interests in maternal health and fetal life. Dividing pregnancy into three trimesters, the Court held that the abortion decision must be left to the pregnant person in consultation with their doctor during the first trimester; that the state may regulate abortion in ways that are reasonably related to maternal health in the second trimester, and that during the third trimester the state may regulate or prohibit abortion, except where necessary, in appropriate medical judgment, for the life and health of the pregnant person.

WEAKENING THE CONSTITUTIONAL PROTECTION FOR ABORTION

While many were thrilled and relieved that abortion was now legal across the country, others were furious and turned to state legislatures to restrict access. From 1973 until 1992, restrictions on abortion were passed in almost every state. Abortion rights activists appealed, but the Supreme Court rejected hearing most of these cases. However, during this time period the Court handed down two major rulings that limited young and poor women’s access to abortion.

In Bellotti v. Baird (1979), the Supreme Court ruled that states could insist that a minor obtain parental consent to obtain an abortion. The Court, however, required that states provide a judicial bypass option, whereby young people could petition a judge for permission to obtain an abortion without notifying their parents if they could show that they were mature enough to make their own decision or that the abortion was in their best interests. Rebecca Suzanne “Becky” Bell was the first person known to die of an illegal abortion because of parental consent laws. On September 16, 1988, the 17-year-old Indiana teenager died of complications from a septic abortion after becoming discouraged from obtaining a legal procedure because of Indiana’s parental consent law.

The Supreme Court also allowed Congress to block Medicaid funding for abortion. When Roe v. Wade legalized abortion, Medicaid — a program funded jointly by the federal government and individual states — covered abortion care as part of comprehensive health care services provided to low-income women. But in 1976, Congress passed the Hyde Amendment, which banned the use of federal funding for abortion care, except in limited cases. Most states followed, instituting bans in their state Medicaid programs. Because so many women depend upon Medicaid for their health care, the Hyde Amendment effectively made it much more difficult for low-income women — disproportionately women of color — to get abortions. On October 3, 1977, a young mother named Rosie Jiménez, pursuing a nursing degree to support herself and her daughter, died after having an abortion in Mexico because Medicaid would not cover the cost of abortion in the United States. She was the first known victim of the Hyde Amendment. In 1980, in Harris v. McRae, the Supreme Court upheld Hyde in a narrowly divided ruling, saying that women’s constitutional rights were not violated by the ban on federal funding for abortions, even if the abortion is medically necessary for a person’s health.

The next major Supreme Court ruling regarding abortion access came in 1992, when the Court, in Planned Parenthood v. Casey, considered a highly restrictive Pennsylvania law that required a 24-hour waiting period, spousal notification, parental consent, a mandate that doctors give biased counseling to people seeking abortion health care, and burdensome reporting requirements. In its decision, the Court abandoned the trimester framework and created a new legal test for allowable restrictions. Before viability — which is the point at which a fetus can survive outside the womb, somewhere between 24 and 28 weeks — the Court allowed restrictions on abortion as long as the law does not place an “undue burden” on a person’s access to abortion. The Court defined an “undue burden” as a restriction that has the “purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion.”

Under this new standard, the Court upheld all of the Pennsylvania restrictions except for spousal notification, which it noted could place women in danger from abusive husbands. The Court allowed states to ban abortion after viability, as long as they had an exception to preserve the life or health of the pregnant person.

In the aftermath of Casey, state and local legislatures began to pass more and more laws to restrict abortion, and the Supreme Court has more often upheld them. In the 2000 case of Stenberg v. Carhart, the Supreme Court struck down a Nebraska statute prohibiting what anti-abortion advocates called “partial birth abortion.” Although the term does not refer to any medical procedure, the law was interpreted as prohibiting doctors from performing an intact dilation and extraction abortion, a type of abortion sometimes used for second trimester abortions. The Court held that if a particular abortion method may be safer in some circumstances, the state may not flatly ban the method, but must allow a maternal health exception to the ban.

But three years later, Congress passed a nearly identical law, the so-called “Partial-Birth Abortion” (PBA) Ban Act of 2003, which was signed into law by President George W. Bush. Abortion rights advocates once again challenged the law, but this time the Court had two new conservative appointees: Justice John Roberts joined the Court in 2005, and Justice Alito in 2006. As a result, the Supreme Court overruled Stenberg v. Carhart and upheld the abortion ban in the 2007 case of Gonzales v. Carhart. This law is one of many instances since Roe of politicians dictating the practice of medicine, without regard for medical science or the health of pregnant people. It also highlights the increasing politicization of the Supreme Court: a candidate’s position on abortion had become a litmus test for Republican presidents.

In her dissent to Gonzales v. Carhart, Supreme Court Justice Ruth Bader Ginsburg decried the ruling, saying:

Today’s decision is alarming … It tolerates, indeed applauds, federal intervention to ban nationwide a procedure found necessary and proper in certain cases by the American College of Obstetricians and Gynecologists (ACOG). It blurs the line, firmly drawn in Casey, between previability and postviability abortions. And, for the first time since Roe, the Court blesses a prohibition with no exception safeguarding a woman’s health.

AN EVER-GROWING NUMBER OF RESTRICTIONS

According to the Guttmacher Institute, since the 1973 Roe v. Wade decision, states have passed more than 1000 abortion restrictions. More than a third of them were enacted between 2011 -2019, accelerating after the election of President Barack Obama. These laws ban abortion after a particular gestational age or based on sex, race, or genetic anomaly, ban specific abortion methods, impose biased counseling and waiting periods, require unnecessary ultrasounds, restrict access to medication abortions, limit who can provide abortion health care, and impose targeted regulation of abortion providers (TRAP) regulations.

TRAP regulations single out abortion providers and facilities by mandating burdensome and medically unnecessary requirements that are more stringent than requirements for other medical procedures of similar risk. For example, TRAP laws sometimes mandate the width of corridors in abortion facilities or that physicians obtain admitting privileges at a nearby hospital (when no nearby hospital is willing to grant them). According to anti-abortion rights activists, the requirements make abortion safer, but there is no evidence that this is true. Abortion is one of the safest medical procedures in the country, far safer than pregnancy and childbirth, and complications are rare. The true intent of TRAP laws is not to improve the safety of abortion but to place onerous restrictions on clinics and abortion providers so that they must stop providing services. According to the Guttmacher Institute, as of 2020, 26 states have TRAP laws or policies in place.

A TRAP law challenge finally reached the Supreme Court in the 2016 case of Whole Woman’s Health v. Hellerstedt (2016). The case involved two provisions of a Texas law that required physicians who perform abortions to have admitting privileges at a nearby hospital and requiring abortion clinics in the state to have facilities comparable to an ambulatory surgical center. The Court ruled that these restrictions violated the Fourteenth Amendment because they imposed an undue burden on abortion access by placing a substantial obstacle in the path of women seeking abortion health care. The Court said that reviewing courts must “consider the burdens a law imposes on abortion access together with the benefits those laws confer” and that courts retain “an independent constitutional duty to review factual findings where constitutional rights are at stake.” Texas tried to justify the restrictions on the grounds of protecting women’s health, but evidence in the record proved that the provisions provided no medical benefit and in fact endangered women’s health. The Court ruled that an uncritical deference to legislative factual findings is inappropriate.

After Donald Trump became president, he appointed two new conservative justices to the Supreme Court — Neil Gorsuch and Brett Kavanaugh — which emboldened anti-abortion rights activists, policymakers and conservative judges. The appointments also emboldened state legislatures. In the first five months of 2019, seven states passed bans on abortion during the first trimester. These are unconstitutional, so long as Roe stands. Georgia, Kentucky, Louisiana, Mississippi and Ohio adopted so-called “fetal heartbeat” bills that prohibit abortions after six weeks of pregnancy, when doctors can usually start detecting embrionic cardiac activity. Missouri passed an eight-week ban. Alabama voted to ban all abortions except to save a pregnant person’s life, with no exception for rape or incest.

Despite the 2016 Whole Woman’s Health decision, the Fifth Circuit Court of Appeals upheld an identical admitting privileges law in Louisiana, purporting to distinguish the effects of the law from the Texas law at issue in Whole Woman’s Health. In June of 2020, the Supreme Court narrowly ruled in June Medical Services v. Russo that the Louisiana law was unconstitutional. Chief Justice Roberts, who had dissented in Whole Woman’s Health, concurred in the judgment to provide a fifth vote striking down the Louisiana law. In his opinion, Roberts criticized Whole Woman’s Health and suggested ways to narrow the undue burden standard in future cases, but he concurred on the grounds of respect for precedent. However, he created a blueprint for states to restrict abortion, and in August 2020, Arkansas enacted four new restrictions. One of these, a ban on “D and E” procedures, prevents the most common method of providing second trimester abortion care. Another requires that abortion providers notify law enforcement officials when a patient 17 years old or younger seeks an abortion.

During the COVID-19 epidemic in 2020, many states banned all non-essential medical procedures. Anti-abortion rights policymakers in twelve states took this as an opportunity, and attempted to close abortion clinics by declaring abortion health care non-essential.  Abortion rights advocates challenged the bans in many states. The battle was particularly fierce in Texas, where a legal challenge went through the court system for weeks, wreaking havoc to abortion access. Courts blocked bans in Alabama, Iowa, Ohio, Oklahoma and Tennessee. The Eighth Circuit Court of Appeals upheld a ban in Arkansas. In response to these restrictions, the American College of Obstetricians and Gynecologies, the Society of Family Planning, and other mainstream medical institutions issued a joint statement affirming that abortion is essential health care and should not be canceled or delayed, because “the consequences of being unable to obtain an abortion profoundly impact a person’s life, health, and well-being.”

PERSONHOOD LAWS

Anti-reproductive rights activists use the concept of “personhood” to attempt to pass laws that define zygotes, embryos, and fetuses as “persons” separate from the pregnant person, and with the full legal rights as a person. The goal of personhood laws is to criminalize abortion as well as certain forms of birth control that work by preventing sperm from fertilizing an egg. Opponents of abortion rights have even used proposed measures to prevent doctors from treating complicated and potentially dangerous pregnancies. Many state legislatures have considered legislation with personhood language, and several have passed them, including Alabama, Kansas and Missouri.

FUNDING ABORTION

In addition to restrictive state laws, the federal Hyde Amendment and subsequent federal and state laws banning public funding for abortion continue to limit access for low-income people, who are disproportionately women of color. Currently Medicaid covers abortion only in cases of rape, incest, or when the pregnant person’s life is endangered by an illness, injury, or physical disorder.

While the Hyde Amendment restricts state Medicaid programs from using federal funds to cover abortion outside the above circumstances, states can use their own funds to cover abortion. In 2020 sixteen states fund abortion services on the same terms as other pregnancy related health services, which means these states use their own funds to cover abortions in circumstances in addition to what the Hyde Amendment allows. Thirty-three states and the District of Columbia follow the federal standard and only provide abortions in the circumstances outlined in the Hyde Amendment. In 2017, over half of reproductive age women on Medicaid — 7.9 million women — lived in states that restrict abortion coverage. The Hyde amendment and its progeny have expanded in scope and currently also limit federal funding of abortion services for federal employees, women in the military and Peace Corps, American Indian and Alaskan native women who use the Indian Health Service, and women in federal prisons and immigration detention facilities.

Currently, under the leadership of women of color organizations and their allies, activists are attempting  to repeal Hyde and restore public funding for abortion health care. In a direct challenge to the Hyde Amendment, Congresswomen Barbara Lee (D-CA), Jan Schakowsky (D-IL), and Diane DeGette (D-CO), introduced the Each Woman Act in 2015 to ensure coverage of abortion for any person, regardless of how much she earns or the type of insurance she has. The All* Above All campaign unites organizations and individuals to lift the bans on public insurance coverage for abortions.

Congress has also blocked foreign aid from covering or even providing information on abortion health care. The Helms Amendment — first passed in 1973 and named after the former ultra-conservative Senator Jesse Helms (R-N.C.) — bars the use of U.S. foreign aid funds to support abortion care. In 1984, Ronald Reagan instituted the Mexico City Policy, which came to be known as the “global gag rule.” Under this gag rule, foreign nongovernmental organizations that want to continue receiving any U.S. family planning funding must agree to stop providing abortion-related services or advocating for the expansion of abortion access, using any source of their funding. The global gag rule has been in place under Republican presidents since 1984, although repealed by every Democratic president. In 2017, Donald Trump expanded the global gag rule to apply to all U.S. global health assistance.

Some members of Congress have fought against these global restrictions on abortion care. In 2019, Sen. Jeanne Shaheen (D-NH) and Rep. Nita Lowey (D-NY) introduced the Global Health, Empowerment and Rights (HER) Act, which would repeal the global gag rule. And in 2020, Rep. Jan Schakowksy (D-Ill.) introduced the Abortion is Health Care Everywhere Act of 2020, the first-ever legislation to repeal the Helms Amendment.

In March 2019, the Trump administration enacted a domestic gag rule, which prohibits U.S. clinics receiving Title X family planning funds from referring their patients for abortion health care. For decades, Title X clinics have provided free or low cost reproductive health care to low-income people. The domestic gag rule has devastated the Title X network’s capacity, cutting it by half.

Prohibitions or restrictions on abortion coverage are not limited only to statutes governing public funding. In 2010, the Affordable Care Act (ACA) was signed into law, extending the Hyde Amendment restrictions on abortion coverage to states’ newly created health insurance exchanges. The ACA also allows states to prohibit abortion coverage entirely in health insurance plans offered through an exchange. Since the law was implemented, twenty-six states have barred health plans participating in the exchange from covering abortion. The ACA also permits providers and facilities to refuse to provide, pay, or refer for abortion services under federal refusal provisions. Forty-six states have similar laws.

Advocates for reproductive health and rights continue to fight the Affordable Care Act’s restrictions on abortion coverage. These restrictions force some people to continue pregnancies they do not want and may put their health or lives at risk. As more states attempt to limit or ban private insurance coverage for abortion services, organizations including the Center for Reproductive Rights and the Guttmacher Institute are pushing to ensure coverage for all pregnancy-related care, including abortion, under the ACA. Private abortion funds around the country attempt to fill the gap created by the myriad restrictions on funding.

PROTECTING ABORTION RIGHTS

Until recently, the battle to keep abortion safe and legal has been largely a defensive battle. However, the reproductive justice movement is pushing a bolder approach. There have been important gains for abortion rights at the federal and state levels. Thirteen states and the District of Columbia have laws affirmatively protecting the right to abortion. Several states have tried to restrict fake pregnancy clinics that mislead and coerce pregnant people to prevent them from accessing abortion, but in the 2018 case of National Institute of Family and Life Advocates v. Becerra, the Supreme Court ruled that a California law regulating fake pregnancy clinics violated the First Amendment. In other gains, several states have passed laws to protect patients and providers from anti-abortion extremists.

For decades, the anti-abortion rights movement has waged a widespread campaign of harassment, violence and terror against abortion doctors, staff, clinics and patients. Their tactics have included blockades of clinic entrances, facility invasions, property damage, stalking, death threats, and physical violence. Anti-abortion extremists have murdered eleven people since the early 1990s — four doctors, two clinic employees, a security guard, a police officer, a clinic escort, and two people who were at an abortion clinic. They have injured many more.

When this violence escalated in the early 1990s, Congress passed the Freedom of Access to Clinic Entrances Act of 1994, which prohibits intentional property damage and the use of “force or threat of force or … physical obstruction” to “injure, intimidate or interfere with” someone entering a health care facility. States have also attempted to protect reproductive health clinics. Fourteen states have laws to protect access to clinics, including laws prohibiting blocking an entrance, threatening or intimidating staff or patients, damaging a facility, making harassing phone calls, creating excessive noise outside a clinic, possessing, having access to a weapon during a demonstration at a facility, trespassing, or releasing a substance that produces noxious odor on clinic premises. Several states have laws creating a buffer zone around clinics or a “bubble zone” around a person within a specific distance of a clinic’s entrance or driveway. In the 2000 decision Hill v. Colorado, the Supreme Court upheld a floating 8-foot “bubble zone” law in Colorado, but in the 2014 case of McCullen v. Coakley, the Court struck down a Massachusetts law that placed a 35-foot buffer zone around clinic entrances. Despite these protections, more than half of all clinics that provide abortion care still report experiencing threats and intimidation against doctors and staff.

To strengthen abortion rights more broadly, advocates are now pushing for the Women’s Health Protection Act, which would prohibit a range of abortion restrictions, including previability bans, state mandates of unnecessary procedures and inaccurate counseling, barriers to telemedicine abortion, TRAP laws, and forcing extra in-person visits to a doctor.

TELEMEDICINE AND MEDICATION ABORTION

Telemedicine abortion combines medication abortion, which uses pills to end a pregnancy, with telemedicine, which allows health care providers meet with patients via videoconferencing or telephone consultations.  

Medication abortion, approved by the FDA for use during the first 10 weeks of pregnancy, uses two different medicines: mifepristone, which interrupts the flow of the hormone progesterone that sustains the pregnancy; and misoprostol, which causes contractions. Misoprostol alone is 80-85 percent effective, and in combination with mifepristone is 95 percent effective. Medication abortion is an extremely safe way to end a pregnancy in the first 12 weeks of gestation. According to the Guttmacher Institute, in 2017 medication abortion accounted for approximately 40 percent of all recorded abortions and 60 percent of abortions performed up to 10 weeks gestation. (The actual rate is likely higher because of the growing number of people who are self-managing their abortions using medication purchased on the internet or obtained in other ways.) 

The growth of medication abortion has dovetailed with the expansion of telehealth to provide new opportunities for accessing abortion health care. As abortion restrictions have increased over the last several years and harassment of people entering health clinics persists — even during the COVID-19 crisis — people are increasingly turning to medication abortion and telehealth to increase their safety and privacy when obtaining abortion care.

Nevertheless, numerous policy barriers limit the reach of telehealth abortion. Many states prohibit patient access to the abortion pill via telemedicine, despite its proven safety. Eighteen states currently require the prescribing clinician to be physically present when prescribing the abortion pill. Thirty-three states require the clinician prescribing the abortion pill to be a physician. Neither of these requirements are necessary because the abortion pill is extremely safe and effective.

Another significant barrier to telemedicine abortion is that the U.S. Food and Drug Administration (FDA) restricts the distribution of mifepristone. When initially approving the drug in 2000, the FDA, under pressure from anti-abortion forces, blocked easy access to mifepristone, using their Risk Evaluation and Mitigation Strategy (REMS) — a drug safety program that allows the FDA to restrict the circulation of certain medications with serious safety concerns to help ensure the benefits of the medication outweigh its risks. Under the REMS program, mifepristone must be dispensed in person at a clinic, medical office or hospital under the supervision of a healthcare provider registered with the drug manufacturer.

However, since 2016, the organization Gynuity has operated a research study on telemedicine abortion called TelAbortion, which allows clinicians participating in the study to provide medication abortion care by video conference and mail without an in-person visit to the abortion provider. The study is currently running in 13 states: Hawaii, Washington, Oregon, New Mexico, Colorado, Georgia, New York, Maine, Iowa, Minnesota, Illinois, Maryland and Montana. This study has shown that telemedicine abortion is safe and effective.

In light of COVID-19, and the need for increased social distancing, advocates are increasingly challenging the FDA’s REMS restrictions on the abortion pill. This effort is supported by recent research on the safety of a no-test medication abortion protocol that allows doctors to screen patients by phone or video and then mail abortion pills directly to them. On March 30, 2020, a coalition of 21 state attorneys general led by California Attorney General Xavier Becerra sent a strongly-worded letter to the U.S. Department of Health and Human Services and its U.S. Food and Drug Administration (FDA), urging the Trump Administration to waive or utilize its discretion on enforcement of its REMS designation. In addition to the attorneys general letter, reproductive health groups are pressuring the government to remove the REMS restriction on the abortion pill. In July of 2020, a federal judge in Maryland issued a ruling temporarily suspending enforcement of an FDA restriction on abortion pills during the pandemic.

As laws, insurance changes and clinic closures have made it increasingly difficult to get an abortion, a growing movement is devoted to helping pregnant people learn self-manage an abortion. Reproductive health advocacy organizations like Aid Access, Plan C, and SASS provide information and support on how to safely obtain and use abortion pills. Some states have passed laws and supported the prosecution of people who have obtained abortion pills and used them on their own. The legal advocacy organization If/When/How: Lawyering for Reproductive Justice has a campaign to push for the decriminalizeation of self-managed abortion, which they argue is particularly critical during the coronavirus epidemic.  They also provide legal information to people with questions about self-managed abortion and their rights.

Access to safe and legal abortion is vital to women’s health and well-being. In 2020, Dr. Diana Greene Foster published the results of a 10-year study on the impact abortion — and being denied abortion — has on women. “The Turnaway Study: Ten Years, A Thousand Women, and the Consequences of Having—or Being Denied—an Abortion” provides definitive evidence that abortion access strongly enhances women’s health and well-being, whereas denying abortion results in physical and economic harm. The constant onslaught of anti-abortion rights measures introduced throughout the country since the 1973 Roe v. Wade decision endangers women’s health and forces reproductive rights and justice activists to challenge each restriction and fight the same battles repeatedly. International bodies, including the United Nations and the World Health Organization, have recognized abortion and reproductive rights as basic human rights. Committed activists will continue to fight for a world where all people have access to safe and legal abortion care.