The History, And Future, of Abortion Medication in America

Written by: Eleanor McKown

Edited by: Janine Rho

Illustrated by: Kate Jang

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In June of 2022, the Supreme Court’s Dobbs v. Jackson ruling left abortion rights in the hands of the states. Essentially overturning Roe v. Wade, a 1973 Supreme Court ruling stating the right to abortion is implicit in the right to privacy, legalizing abortion in the United States. This event triggered legislative changes, where some states fully banned abortion, and some protected the right to an abortion. By tracing the development of abortion methods and legislation from the 1800s to the present, we can better understand how recent legal shifts may shape the future of reproductive healthcare. The history of reproductive care in America has been shaped by medical advancements, legal regulations, and public health outcomes. Advancements in contraception methods and termination methods, along with changes in accessibility to reproductive care, have significantly impacted maternal health. Examining these shifts and past outcomes can provide insight into what the future of reproductive care may look like.

During the 1800s, anything sexual was considered taboo and rarely spoken about publicly. However, there was no birth control, so how did people prevent pregnancy? Personal journals written by affluent women gave us a glimpse into the birth control methods they used [2]. The main method used to prevent pregnancy was cycle tracking. They would avoid intercourse during and up to sixteen days after menstruation. In addition, it was thought that breastfeeding would prevent pregnancy. If these methods didn’t work and a woman found herself pregnant and not wanting to be, what would they do? It was rare to find someone to induce a miscarriage; so, often, they would do it themselves using vigorous exercise. This involved walking or horseback riding for long periods of time. Likely the most common method, though, was coitus interruptus, often referred to as withdrawal, where the penis is withdrawn before ejaculation to prevent pregnancy [2].   

Although abortion was looked down on, both by society and the church, it was rare that legal actions were taken. Puritans, a group of English Protestants, viewed abortion and miscarriage as a sin and were influential in moral and ethical issues. They believed that they were disobeying God by intervening in life. But the legality of abortion in Great Britain was different. After the first movement of the fetus, referred to as the “quickening,” it was illegal for an abortion to be performed. This was not the case in America before the mid-1800s. In 1847, the American Medical Association (AMA) was formed, later advocating against abortion and restricting who could provide an abortion [18]. Pregnancy care was now in the power of physicians, not midwives. In the 1800s, midwives tended to be trained women who provided holistic care, allowing for more patient autonomy, while physicians tended to be men. The death rates following abortion between physicians and midwives were similar, yet physicians blamed midwives for these poor outcomes [18]. Even with this changing landscape, the first legal action surrounding reproduction was not until 1873. This shift in medical authority laid the groundwork for the 1873 Comstock Act which prohibited the sale of birth control [9]. At this point in time, condoms were new and not widely used, and oral birth control had not yet been invented. This was the beginning of the criminalization of abortion. By 1910, aside from Kentucky, there was a nationwide abortion ban.

By 1930, around 20%  of maternal deaths were due to abortion [8] [15]. But because abortion was illegal, this was unregulated and often a dangerous, back-alley procedure; sometimes even self-induced using foreign objects. After antibiotics were introduced, the maternal death rate during pregnancy declined [11]. However, 17% of pregnancy-related deaths were still due to abortion in 1965 [8]. This was primarily accounted for by low-income people of color who were less likely to find safe abortion procedures. On January 22, 1973, in the case of Roe v. Wade, the Supreme Court declared the right to abortion was implicit in the right to privacy, legalizing abortion [4]. At the same time, the surgical abortion procedure of vacuum curettage was introduced. This procedure, which is still the most common surgical abortion procedure, involves dilating the cervix and inserting a tube called a cannula to remove tissue from the uterus. This made surgical abortions safer and quicker [14].

The development of misoprostol and mifepristone changed the game for abortion procedures. Misoprostol is an oral medication that can be used to expel pregnancy tissue and, when combined with mifepristone, a pregnancy can be successfully terminated [7]. Mifepristone is known as an anti-progestin. Progesterone is a naturally occurring hormone that plays a large role in pregnancy development. An anti-progestin, like mifepristone, ends the development of a fetus. Misoprostol causes contractions in the uterus and dilates the cervix. This replicates the process of labor. Thus, mifepristone ends the continued development of a pregnancy, and misoprostol rids the body of these tissues. These medications combined effectively end a pregnancy. It was first developed in France in 1982 and known as RU-486 [3]. In 2000, the US Food and Drug Administration (FDA) approved misoprostol and mifepristone in the United States [16]. Until 2021, these medications were easily accessible. 

The right to an abortion was legally safe in the United States until 2021. In 2021, abortion became restricted in 19 states due to the Supreme Court’s 6–3 anti-abortion majority, encouraging state legislators to enact abortion restrictions [13]. This included 15-week abortion bans, 6-week bans, and total bans. Around half of all abortions are completed using misoprostol and mifepristone, with 91% of abortions being done before 13 weeks [1]. Providers are only allowed to dispense medication if they can accurately determine how far along the pregnancy is, ensure that the pregnancy is developing correctly, and provide or refer to emergency care if necessary [1]. Before these regulations were put in place, there were around 1500 abortion providers nationwide. Since this ban, the number continues to decrease. It should be noted that of the people who receive an abortion, 59% are under the age of 25 [7].

As political policies continue to evolve, so too will the accessibility and safety of abortion medication. It is possible that, with increasing technology, access to these drugs in remote areas will become easier. Or perhaps it may become even more difficult due to the shifting political landscape. If abortion medication is completely inaccessible, there will likely be a rise in abortion related maternal deaths. When people don't have access to safe medication, they may resort to other, more dangerous methods. However, the death rate is unlikely to reach as high as it was before the introduction of antibiotics. Furthermore, there are other contraceptive methods being innovated. Some include male contraceptives and more non-hormonal options. These could play a key role in reducing unwanted pregnancy rates. But the real determinant of change in our future is our generation's role. We have the ability to push for reproductive rights and accessibility to shape our future.

At this point in time, the future of reproductive care is uncertain. Will abortion care become restricted in more states or will we see a wave of protections and expanded rights? The landscape is shifting rapidly; only time will tell.

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References

[1] Beaman, J., Prifti, C., Schwarz, E. B., & Sobota, M. (2020). Medication to manage abortion and miscarriage. Journal of General Internal Medicine, 35(8), 2398–2405. https://doi.org/10.1007/s11606-020-05836-9

[2] Brodie, J. F. (1997). Contraception and abortion in nineteenth-century America. Cornell University Press.

[3] Charo, R. A., & Hanna, K. E. (1991). A political history of RU-486 (pp. 43-91). Washington, DC: National Academy Press.

[4] Garrow, D. J. (2015). Liberty and sexuality: The right to privacy and the making of Roe v. Wade. Open Road Media.

[5] Gemmill A, Franks AM, Anjur-Dietrich S, et al. US Abortion Bans and Infant Mortality. JAMA. Published online February 13, 2025. doi:10.1001/jama.2024.28517

[6] Hardy, J. E. (1990, April 20). Abortion in America. Scholastic Update, 122(16), 4+. https://link.gale.com/apps/doc/A8962103/AONE?u=nysl_oweb&sid=googleScholar&xid=21e1f16c

[7] Gemzell-Danielsson, K., & Lalitkumar, S. (2008). Second trimester medical abortion with mifepristone–misoprostol and misoprostol alone: a review of methods and management. Reproductive health matters, 16(31), 162-172.

[8] Gold, R. B. (2003, March 1). Lessons from before Roe: Will past be prologue? Guttmacher Policy Review, 6(1). Retrieved June 2, 2025, from https://www.guttmacher.org/gpr/2003/03/lessons-roe-will-past-be-prologue

[9] Hamlin, K. A., Cahill, C. D., Cohen, A. W., Lange, A. K., Thompson, L. M., Syrett, N. L., & Zier, M. (2024). The History and Legacy of Anthony Comstock and the Comstock Laws. The Journal of the Gilded Age and Progressive Era, 23(4), 431-437.

[10] Hovey G. (1985). Abortion: a history. Planned parenthood review, 5(2), 18–21.

[11] Løkke, A. (2012). The antibiotic transformation of Danish obstetrics. The hidden links between the decline in perinatal mortality and maternal mortality in the mid-twentieth century. In Annales de démographie historique (Vol. 123, No. 1, pp. 205-224). Belin.

[12] Missouri Secretary of State - IT. (n.d.). 2024 ballot measures. Missouri State Seal. https://www.sos.mo.gov/elections/petitions/2024BallotMeasures 

[13] Nash, E. (2022, January 5). State policy trends 2021: The worst year for abortion rights in almost half a century. Guttmacher Institute. Retrieved June 2, 2025, from https://www.guttmacher.org/article/2021/12/state-policy-trends-2021-worst-year-abortion-rights-almost-half-century

[14] Nathanson, B. N. (1971). Suction curettage for early abortion: experience with 645 cases. Clinical Obstetrics and Gynecology, 14(1), 99-106.

[15] Planned Parenthood Action Fund. (n.d.). Historical abortion law timeline: 1850 to today. Retrieved June 2, 2025, from https://www.plannedparenthoodaction.org/issues/abortion/abortion-in-us-history/historical-abortion-law-timeline-1850-to-today

[16] Simmonds, K. E., Beal, M. W., & Eagen‐Torkko, M. K. (2017). Updates to the US food and drug administration regulations for mifepristone: implications for clinical practice and access to abortion. Journal of Midwifery & Women's Health, 62(3), 348-352.

[17] Stubblefield, Phillip G. MD; Carr-Ellis, Sacheen MD; Borgatta, Lynn MD, MPH. Methods for Induced Abortion. Obstetrics & Gynecology 104(1):p 174-185, July 2004. | DOI: 10.1097/01.AOG.0000130842.21897.53 

[18] Whittum, M., & Rapkin, R. (2022). History of abortion legislation in the United States. Journal of Gynecologic Surgery, 38(5), 320–323. https://doi.org/10.1089/gyn.2022.0060