Mifepristone + Misoprostol
This design file is a work in progress and was last updated on 7 July, 2022. We welcome contributions, corrections, and updates. Read Collecting Design (Digitally) at M21D to learn more about our approach to collecting design.
Materials: One Mifepristone pill, also known as RU-486 (C29H35O2), and one to four Misoprostol (C22H38O5) pills
Carbon footprint: ongoing research
Energy: ongoing research
Labor: ongoing research
Equality: Medication abortion helps people with a uterus maintain bodily autonomy. In most cases, this allows women and transmasculine people equal treatment under the law to cisgender men.
Access: Medication abortions are physically safe to complete anywhere, provided the patient is less than ten weeks pregnant. People living in jurisdictions that have criminalized abortion may still be able to access the necessary medication through unconventional means.
Creators: French pharmaceutical firm Roussel Uclaf, released in 1988.
Medication for Accessible, Safe, and Private Abortions
Medication abortions allow people to terminate pregnancies in the privacy and comfort of their home, making the healthcare procedure far more attainable than in-clinic procedures. (These drugs are not to be confused with emergency contraception, often called the morning-after pill, which temporarily stops the release of an egg from the ovary and prevents a fertilized egg from attaching to the uterus lining.)
Medication abortions use two pharmaceuticals to block the supply of hormones that maintain the uterus's interior lining and expel its contents. Patients first take 200mg of Mifepristone, which blocks the production of progesterone and causes the uterine lining to weaken, followed by one to four doses of Misoprostol, which expels the lining so that the embryo detaches from the uterine wall. According to the Mayo Clinic, the combination of Mifepristone and Misoprostol is 97% effective during the first 63 days of pregnancy. The regiment is also effective in the second trimester of pregnancy, although the level of effectiveness dips to around 93%, according to Planned Parenthood.
The images in this design file are from Womenonwaves.org, an organization that helps educate people on Mifepristone and Misoprostol and delivers critical reproductive care to those who can't access them.
Easy Access to Safe and Legal Abortions Help to Repair Sexist, Racist, and Classist Political Systems
The mountain of evidence agrees: egalitarian societies regarding race, economic status, gender, and sexuality require that everyone have easy access to reproductive healthcare that includes abortion.
On gender and sexuality, see:
“Being Denied an Abortion Has Lasting Impacts on Health and Finances,” by Mariana Lenharo for Scientific American.
“How the reversal of Roe v. Wade could impact the transgender community,” Ayen Bior for NPR.
“Key Facts on Abortion,” Amnesty International.
“The Right to Reproductive Autonomy: A 14th Amendment Guarantee,” by Diana Kasdan and Risa Kaufman for Ms.
“Roe v Wade: men benefit from abortion rights too – and should speak about them more,” Dr. Stephen Burrell and Dr. Sandy Ruxton for The Conversation.
“Safe and Legal Abortion is a Woman’s Human Right,” Center for Reproductive Rights
“Transgender advocates say the end of Roe would have dire consequences,” by Olivia McCormack for The Washington Post.
“What Happens When Women Can’t Get Legal Abortions,” By Neha Wadekar for Foreign Policy.
On race, see:
“The Color of Choice: White Supremacy and Reproductive Justice,” by Loretta Ross for SisterSong Women of Color Reproductive Health Collective on personal experience and quantitative data on abortion restrictions.
“Race-ing Row: Reproductive Justice, Racial Justice, and the Battle for Roe v. Wade,” an article in the Harvard Review by professor Melissa Murry on race and abortion in America.
“Structural Racism and the Criminalisation of Abortion in Brazil,” by Lívia Casseres for the International Journal on Human Rights.
“Why abortion restrictions disproportionately impact people of color,” by Jessie DiMartino and Kiara Alfonseca for ABC News.
On economic status, see:
“Abortion rights are economic rights,” by Asha Banerjee for Economic Policy Institute.
“Abortion Limits Carry Economic Cost For Women,” by Scott Horsley for NPR.
“The Devastating Economic Impacts of an Abortion Ban,” by Sheelah Kolhatkar for the New Yorker.
“Social and Economic Correlates of Induced Abortion in Santiago, Chile,” Professor Mariano Requena for Demography.
“The war on abortion drugs will be just as racist and classist,” by Vanessa Williamson and John Hudak for Brookings Institute.
“What can economic research tell us about the effect of abortion access on women’s lives?,” by Caitlin Knowles Myers and Morgan Welch for Brookings Institute.
Of course, these three sectors overlap immensely, and you’ll find references to intersectional equality in each piece.
It’s important to note that this design file focuses on the morality of the outcomes of abortion access for a more egalitarian world. The question of the morality of the act itself is not addressed. Robert Streiffer at the University of Wisconsin-Madison’s syllabus on the ethics of abortion offers an entrance into that wide-ranging debate.
Designing Ways of Circumventing Limitations to Healthcare Access
The existence of Mifepristone and Misoprostol does not guarantee people access to them. People and institutions have designed political systems and policies to create barriers between the medication and those who need it most.
Every jurisdiction designs laws that control access to Mifepristone and Misoprostol differently, a reality that complicates the simple home procedure. All abortions, including medication abortion, are currently or about to be criminalized as feticide or manslaughter in 26 out of 50 states in the USA, according to the Guttmacher Institute. The legal status of abortion varies significantly across Asia. Because China and India, the two most populous countries, have liberal abortion laws, most people in Asia have legal access to in-clinic and medication abortions. But in other countries, including Iraq, Laos, and the Philippines, abortion for any reason is banned. In Africa, an estimated 93% of women live in countries with restrictive abortion laws. In Latin America, fewer than 3% of women live in countries where abortion is conditionally legal. In Europe, abortion is illegal in Germany, Andorra, Liechtenstein, Malta, Monaco, Poland, and San Marino, and high barriers to accessing abortion exist in an additional thirteen European countries, according to a report from The Center for Reproductive Rights.
The illegality or criminality of abortion across the globe creates one among many barriers for those seeking healthcare. Many people face obstacles, including difficulty finding providers willing to perform abortion, substandard conditions in health facilities, lack of awareness of the legal status of abortion, and fear of stigmatization for terminating a pregnancy. But because medication abortion relies only on two to five small pills, people can access the necessary medication online (legally and illegally) or across borders. And people are taking advantage of this. More than 700,000 people in the U.S. in 2016 typed questions about at-home abortions into Google, including “buy abortion pills online” and “free abortion pills,” according to the New York Times. An NPR report from 2016 offers a personal look at what greater access to medical abortion means to people living where in-clinic abortions simply aren’t possible.
While illegal medication abortions aren’t without risks, they’re typically seen as the best option. One of those risks includes being charged with crimes. State officials have increasingly charged women for buying or taking it illegally, with several facing felony charges and jail time. However, it’s still likely the safer option amongst others for DIY abortions, including, according to Allure, using a hanger; consuming fungus ergot, tansy oil, opium, gunpowder, or turpentine; spending the night in the snow; throwing oneself down a staircase, or hitting oneself in the stomach.
Going against Design to Provide Care
Misoprostol was not designed for medication abortions. The American pharmaceutical company Searle invented Misoprostol to treat peptic ulcers by preventing harsh gastric secretions. When it was released in 1973, it was already known to have significant side effects on a pregnant uterus. It would later become a drug used to induce labor and assist in medication abortions.
People in Brazil, where abortion is illegal, began using Misoprostol to induce abortions when the drug was first approved for ulcer treatment in 1986. People in Texas learned from their neighbors, and the rate of Misoprostol sales increased as regulation of abortion providers increased over the past 40 years.
Indeed, it wasn’t until seven years after the release of Misoprostol that its companion Mifepristone was developed to assist in medication abortions. In the 1980s, the researchers at Roussel Uclaf developed Mifepristone to complement how people were already reapplying Misoprostol to have home abortions. France legalized the regimen of Mifepristone and Misoprostol in 1988, and China, Great Britain, and Sweden soon followed suit.
The world won’t have the same opportunity for safe and private abortions without the people who went against the pharmaceutical industry’s intended use of a design to fit it to their own needs.
M21D and Mifepristone + Misoprostol
The development, use, and circulation of Mifepristone and Misoprostol demonstrate how design can be applied in intended and unintended ways to encourage social equality and save lives. At M21D, the staff and the institution stand with women, transmasculine people, and everyone else seeking equality under the law and the ability to make decisions about their bodies, families, and futures.
26 States Are Certain or Likely to Ban Abortion Without Roe, Guttmacher Institute
Abortion in Africa, Guttmacher Institute
Abortion in Asia, Guttmacher Institute
Abortion in Latin America and the Caribbean, Guttmacher Institute
The Abortion Pill, Planned Parenthood
A Mother in Jail for Helping Her Daughter Have an Abortion, The New York Times
Emergency Contraception, Planned Parenthood
European Abortion Laws A Comparative Overview, Center for Reproductive Rights
For Privacy’s Sake, Taking Risks to End Pregnancy, The New York Times
Mifepristone, Mayo Clinic
The Return of the D.I.Y. Abortion, The New York Times