THE ABORTION PILL'S EXILE IN OBSCURITY

Twenty-one years after its approval by the FDA, mifepristone could—but probably won’t— revolutionize a post-Roe world

- CYNTHIA KOONS

Mifepristone may be the least marketed pharmaceutical product in the U.S. There aren’t any ads for it on TV. Most doctors can’t prescribe it. Pharmacists don’t know much about it, since it doesn’t sit on the shelves at CVS or Walgreens. It would be reasonable to assume this is all because mifepristone is exceptionally dangerous. But it sends fewer people to the ER than Tylenol or Viagra. It’s also highly effective when used as intended: to induce an abortion.

When the U.S. Food and Drug Administration approved mifepristone 21 years ago, it was known as RU-486 and hailed as the most important advance in reproductive health since the birth control pill. Time magazine had called it “The Pill That Changes Everything.” It was supposed to provide an attractive alternative to surgical procedures, which can involve sedation, a visit to a health-care facility, and obviously a great deal of medical expertise. At the time, the abortion battleground was, by and large, women’s health clinics. The pill, in theory, could allow women to bypass clinics, and throngs of protesters, almost entirely.

Yet in the two decades since FDA approval, mifepristone has failed to reach liftoff. If anything, it’s receded from view. A labyrinth of regulatory restrictions has kept it intentionally out of reach. Most abortions in the U.S. are still done by surgical procedure, even though the majority of people ending their pregnancy do so early enough to take the pill instead. Almost 80% of adults, including two-thirds of women, don’t even know medication abortion exists, according to the Kaiser Family Foundation.