Revolutionary pills? Feminist abortion, pharmaceuticalization and reproductive governance
By: Madeleine Belfrage (she/her)
Global media attention has turned to abortion pills in the wake of the U.S.-Supreme Court Dobbs decision that eliminated the constitutional right to abortion in the United States. Activists on both sides of the United States-Mexico border are organizing to ensure women and pregnant people can safely self-induce abortion using medication despite the laws. In Europe, activists have also sent shipments of abortion pills to their colleagues in Ukraine as part of essential humanitarian aid.
Some stories sensationalize the movement of pills by describing an ‘underground’ networks of transnational activists who move pills ‘illegally’. Anti-abortion lobbyists and some media outlets have described the provision of pills as ‘trafficking’. In reality, self-managed abortion using pills is recommended by the World Health Organization and has been a significant part of public health programs globally for decades. In Latin America, informal use of pills to induce abortions has occurred since the 1980s and has long been a strategy of feminist activists to ensure women’s bodily autonomy in the face of criminalizing laws and unsafe clandestine surgical practices.
My research with activists in Mexico looks at what is termed ‘accompaniment’ practice, the ways trained feminist grassroots collectives support women to self-induce abortions using pills. In my article Revolutionary pills? Feminist abortion, pharmaceuticalization and reproductive governance I focus on the globalizing economic and political dynamics that facilitate and impede activists’ access to two medications used to induce abortion: misoprostol and mifepristone.
For activists, pills facilitate bodily autonomy. They allow women to perform their own abortions at home, in supportive relationships with activists and peers. However, pills are also a part of assemblages of pharmaceuticalized medicine, where private sector organizations have become protagonists in the provision of abortion healthcare and the governance of reproductive conduct. Abortion pills are not only controlled through state regulation, but also monopolies in supply and distribution. My research on these dynamics shows that it is often the very actors and structures which attempt to make abortion pills available that negatively affect people’s reproductive autonomy.
Neoliberal economic conditions (for example the deregulation of economies and liberalization of trade barriers that have made it easier for corporations to operate across nation-state borders) have increased the mobility of abortion pills and information. Yet social scientists have drawn attention to the ways neoliberalism has also signaled transformations in how populations are governed beyond laws and other centralized mechanisms of state control. Abortion pills, and those of us who use them, may escape laws; however, they (we) are subject to other forms of governance.
Sexual and reproductive health programs that supply and distribute abortion pills globally rely on for profit-models and neoliberal logics that link consumerism with responsible reproductive choices and behavior. I found that practices like charging a fee for pills, were couched in moralizing discourses about ‘co-responsibility’. Women were discouraged from ‘repeat’ abortions and other ‘irresponsible’ reproductive conduct through economic disincentivizing. These logics are part of broader tendencies in sexual and reproductive rights programs that frame the use of contraception as moral and rational reproductive behavior and stigmatize abortion as a failure of such conduct.
Activists, including those who operate outside NGO programs, rely on these actors to obtain abortion pills, particularly mifepristone. However, part of the autonomous politics of accompaniment practice is to draw pills into new relationships and logics based on principles of solidarity, justice, and bodily autonomy. For example, many activists chose to use misoprostol only, rather than the combined regime using mifepristone. Misoprostol is available cheaply over the counter in many pharmacies, decentralizing the ways women and pregnant people can obtain the pills. Activists also used techniques like pill sharing and pharmacy monitoring to address economic inequalities.
My research contributes to important global conversations about the ongoing transformations in abortion provision and the importance of decentralizing and demedicalizing abortion healthcare. As Kinga Jelinska, CEO of global activist organization Women Help Women, said at a recent international abortion conference, the potential for pills to revolutionize the abortion landscape is happening now. It is the present, not the future. We need to find more ways to democratize access to abortion using medication to ensure that pills are tools for bodily autonomy and not another way to control reproduction.
Read the full article here: Revolutionary pills? Feminist abortion, pharmaceuticalization and reproductive governance.
This article was named the winner of the 2021 Enloe Award.
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Madeleine Belfrage is a PhD candidate at the School of Social Science at the University of Queensland, Australia. She has worked on sexual and reproductive rights and feminist grassroots funding in Mexico since 2015. Her research interests include abortion stigma, self-managed abortion, Latin American feminisms, reproductive governance, and neoliberalism. Other recent publications include Cuerpo-territorio y aborto: propuesta teórica para cuestionar la gobernanza reproductiva violenta (Belfrage, 2021) and Voicing abortion experiences to reduce stigma: lessons from of an online storytelling platform in Mexico (Belfrage, Didier & Vázquez Quesada, 2021).