Protecting Women: The Real Dangers of Restricting Reproductive Healthcare
- Ash A Milton
- 53 minutes ago
- 11 min read
Why Medication Abortion Access Is Essential Healthcare, Not a Public Health Threat
The narrative surrounding medication abortion has been deliberately distorted by those seeking to restrict women's access to essential healthcare. Claims that chemical abortion drugs are dangerous ignore a quarter-century of evidence demonstrating their remarkable safety and efficacy. The misuse of any medication is not justification for removing access to healthcare—yet this flawed logic continues to threaten women's autonomy and wellbeing. The real dangers women face are not from safe, FDA-approved medications, but from the systematic barriers erected to prevent them from accessing the care they need.
Twenty-Five Years of Proven Safety
Since the FDA approved mifepristone in 2000, medication abortion has demonstrated an exceptional safety record. Over 7.5 million women in the United States have used mifepristone and misoprostol for medication abortion, with research consistently showing it to be highly safe and effective. The National Academy of Science, Engineering, and Medicine conducted a comprehensive review and found medication abortion to be extremely safe and effective, with a safety rate exceeding 99%. In fact, medication abortion is safer than continuing a pregnancy to term and safer than common medications like penicillin, Viagra, or Tylenol administered in outpatient settings.
The success rate for medication abortion is 95% or higher when used for pregnancies up to 10 weeks. Serious complications are rare, occurring in only 0.65% of cases according to data from hundreds of thousands of procedures. When complications do occur, they are typically manageable with standard medical care. The mortality rate is extraordinarily low—0.4 per 100,000 procedures over a two-year period—making it one of the safest medical procedures available.
By 2023, medication abortion accounted for 63% of all abortions in the United States, up from 53% in 2020. This increase reflects not danger, but improved access through telemedicine and evidence-based policy changes that removed medically unnecessary restrictions. The COVID-19 pandemic accelerated this trend as healthcare providers recognized the benefits of allowing patients to access this safe procedure without unnecessary in-person visits.
The Real Threat: Intimate Partner Violence During Pregnancy
The narrative of women being coerced into abortions ignores a far more prevalent and deadly reality: intimate partner violence against pregnant women. Between 2016 and 2022, 5.4% of pregnant women experienced intimate partner violence. Even more alarming, homicide is a leading cause of death for pregnant and postpartum women, accounting for 31% of maternal injury deaths. Approximately 40% of homicides among pregnant people or within a year of pregnancy are related to intimate partner violence.
In 2018-2019, the homicide rate for women ages 15-44 was 16% higher among those who were pregnant or within one year of pregnancy compared to those who were not. Almost half (45.3%) of homicides of women who were pregnant or within one year of pregnancy involved intimate partner violence. Women who were pregnant or recently pregnant at the time of their death were 14% more likely to die from homicide at the hands of an intimate partner compared to women who were not pregnant.
States with limited access to abortion experience significantly higher rates of intimate partner homicide among pregnant and postpartum women. Research shows that states categorized as restrictive to abortion access had a 75% higher rate of peripartum homicide. Firearms were the most frequent weapon used, accounting for 63.4% of peripartum homicides. These statistics reveal that the greatest threat to pregnant women is not medication abortion—it is violence from intimate partners, a danger that is exacerbated in states that restrict reproductive healthcare access.
For many women, pregnancy is not a time of joy but of increased danger. Over two-thirds of people who experienced violence by a current intimate partner during pregnancy also experienced it before pregnancy. Violence during pregnancy can result in bodily injury, head trauma, pregnancy complications, premature birth, low birth weight, and even fetal death. Women experiencing intimate partner violence are more than twice as likely to experience depression, smoking, and substance use during pregnancy. They are also less likely to attend prenatal care visits or may delay beginning care.
Barriers to Women's Reproductive Autonomy
Women seeking control over their reproductive lives face systematic barriers that reveal the double standards embedded in healthcare. When it comes to permanent sterilization, countless women report being denied tubal ligation procedures because they are considered too young, don't have enough children, aren't married, or might change their mind—or because a hypothetical future partner might want children.
Research shows that 45% of physicians would discourage a woman with one child from having a tubal ligation, while 29% would discourage a woman with three children.
The patronizing nature of these denials is stark. Women in their 30s and even 40s have been told they are too young for sterilization. Some doctors have required spousal consent—even when not legally mandated—creating a barrier where women must obtain permission from their husbands for procedures involving their own bodies. One woman reported needing her husband's signature for her tubal ligation, while he required no spousal consent for his vasectomy. Another was denied a hysterectomy for endometriosis because she might want children with a man in the future—despite being seated next to her wife during the appointment.
These denials force women to endure years of unwanted pregnancies, expensive and often ineffective contraception, and health complications. The American College of Obstetricians and Gynecologists states clearly that nobody who seeks sterilization should be denied, yet women continue to face rejection after rejection. Some spend years seeking a physician who will respect their reproductive autonomy, with one woman reporting she asked a different doctor every year for five years before finding one willing to perform the procedure. It is not possible to find quantitative data on this topic.
Following the Dobbs decision, tubal ligation requests from young women have more than doubled, and vasectomy requests have tripled.
Women cite fear of losing autonomy over their bodies and concerns about being forced to carry unwanted pregnancies in states with abortion bans. The demand for permanent sterilization reveals that many women are so terrified of losing reproductive control that they are opting for surgical procedures to ensure their bodily autonomy.
The Gender Pain Gap in Healthcare
Women's pain is systematically dismissed, minimized, and untreated across the healthcare system. Research consistently shows that women in pain wait longer in emergency rooms, receive fewer pain medications, and are more likely to have their pain attributed to psychological causes than men with identical symptoms. Women wait an average of 65 minutes before receiving an analgesic for acute abdominal pain in emergency rooms, while men wait only 49 minutes. Women who received coronary bypass surgery were only half as likely to be prescribed painkillers compared to men who underwent the same procedure.
The dismissal of women's pain is particularly egregious in reproductive healthcare. Procedures like IUD insertions, which can cause severe pain, are routinely described to women as feeling like "just a pinch." Women report being told their pain is normal, that they should "bleed it out," or that they need psychiatric help rather than medical treatment. Research shows that 70% of people impacted by chronic pain are women, yet 80% of pain studies are conducted on male mice or human men.
In my personal experience of having two IUDs the pain was incredible. As I screamed out the doctor reassured me that it would be over quickly. I was advised to get some over the counter pain medicine from my US doctor, in Germany I was advised to drink some wine after the procedure.
This exclusion of women from medical research extends far beyond pain studies. Women were historically excluded from clinical trials, and it wasn't until 2016 that the National Institutes of Health required sex to be considered as a biological variable in most studies it funded.
As a result, current pain management strategies remain predominantly based on male-centric models, leading to unequal and less effective care for women. The healthcare system has failed to recognize that women experience pain differently and more frequently than men, with higher prevalence rates of both acute and chronic pain conditions.
Gender biases in pain perception mean that healthcare providers often perceive women's pain as less severe than men's, even when women report identical or higher pain levels. Women are more likely to be offered psychotherapy instead of medication for pain, and their physical pain is often attributed to psychological causes. When women persist in seeking care for severe pain, they may be labeled as "difficult" patients or accused of exaggerating their symptoms. The result is delayed diagnoses, inadequate pain management, and increased suffering for conditions like endometriosis, which affects 11% of reproductive-age women but often takes years to diagnose.
The Economic Burden: Healthcare's Pink Tax
Women face higher healthcare costs simply because they are women. Research shows that women have approximately 18% higher annual out-of-pocket healthcare costs compared to men—and this excludes pregnancy-related costs. Women spend approximately 10% more on total health expenditures relative to men. Combined with the ongoing gender wage gap, where women earn only 82 cents for every dollar men earn (and even less for women of color), these higher healthcare costs create a significant financial burden.
Menstrual products—which are necessities, not luxuries—are taxed in 21 states as luxury items.
Tampons alone cost women an average of $1,773 over a lifetime. This "tampon tax" contributes to period poverty, where many women struggle to afford basic menstrual products. The cumulative effect of these price disparities means women can spend thousands of dollars more than men over a lifetime simply for being female.
Recently, when SNAP benefits were withheld, I assisted a mother in need who shared in a local group that she had to choose between buying food and period products. For her and her two teenage daughters, I spent nearly $50.00 to cover a month's supply of period products. No one is trying to scam the government for tampons and pads!
Women also face higher costs for reproductive healthcare services. Despite the Affordable Care Act's (ACA) requirements for contraceptive coverage, many women still face steep copays and prior authorization requirements that create barriers to care. Without ACA this is projected to become worse. As of 2022, only 20 states mandated coverage for infertility diagnosis and treatment, and fewer required coverage for assisted reproductive technologies. This unequal coverage exacerbates the financial burden women face and can discourage them from seeking or remaining compliant with necessary care.
Criminalizing Interstate Healthcare: A Constitutional Crisis
Some states have taken the unprecedented step of attempting to criminalize women's constitutional right to travel across state lines to access legal healthcare.
These efforts represent a dangerous erosion of fundamental freedoms. Idaho became one of the most extreme anti-abortion states with a law that expressly criminalizes assisting a minor in obtaining an out-of-state abortion, punishable by two to five years in prison. Tennessee has enacted similar legislation. Four Texas counties have passed "abortion trafficking" ordinances that allow private citizens to sue anyone who travels through their jurisdictions to obtain an abortion in another state.
These laws criminalize helping someone access legal healthcare in another state. Under these provisions, giving money to a pregnant person, providing a ride, helping organize a visit to an out-of-state doctor, or even providing information about how to access abortion care could be considered criminal activity. Alabama's Attorney General threatened to prosecute individuals and organizations using conspiracy laws for facilitating legal out-of-state abortions, prompting federal intervention and a federal court ruling that such prosecutions would violate the constitutional right to travel.
The Justice Department has filed statements affirming that the Constitution protects the right to travel across state lines and engage in conduct that is lawful where it is performed. Justice Brett Kavanaugh explicitly stated in his Dobbs concurrence that states cannot bar residents from traveling to another state to obtain an abortion based on the constitutional right to interstate travel. Yet despite these clear legal precedents, states continue to pass laws designed to intimidate and deter women from exercising their constitutional rights.
The number of people crossing state lines to obtain abortion care more than doubled from 81,000 in 2020 to 171,000 in 2023. Women are traveling primarily to states bordering those with total abortion bans. Illinois, which borders three states with total bans, saw an increase of 13,300 out-of-state patients. New Mexico, Colorado, and other states with protective policies have experienced dramatic increases in interstate patients. These women are not criminals—they are individuals seeking constitutionally protected healthcare.
Twenty-two states have responded by adopting "shield laws" to protect providers and patients from investigations and prosecutions by states with abortion bans. These protective measures demonstrate the constitutional crisis created when some states attempt to extend their laws beyond their borders. The fundamental principle that individuals have the right to travel to obtain legal services in another state should not be controversial—yet it has become a battleground as anti-abortion activists attempt to control women's healthcare decisions even outside their state's jurisdiction.
The Underfunded Reality of Women's Health Research
Women's health remains one of the most legislated and least researched areas of medicine. The systematic exclusion of women from clinical trials and medical research has created dangerous gaps in knowledge about how to effectively treat half the population. Current medical practices are based predominantly on male physiology, leading to suboptimal outcomes for women across virtually every medical specialty.
The consequences of this research gap are severe and far-reaching. Women experience different symptoms for conditions like heart disease but are evaluated based on male symptom profiles, leading to delayed diagnosis and treatment. Studies show that young female patients presenting to emergency departments with chest pain experience 29% longer wait times for heart attack evaluation compared to male counterparts, and they are less likely to receive appropriate testing and medications.
Conditions that predominantly affect women, such as endometriosis and polycystic ovary syndrome, remain chronically understudied and underfunded. Endometriosis, which affects approximately 11% of reproductive-age women and causes debilitating pain, often takes 7-10 years to diagnose because medical professionals are inadequately trained to recognize and treat it. Women suffering from these conditions face dismissive attitudes from healthcare providers who minimize their symptoms or attribute them to psychological factors.
Medication Abortion: Access Is Healthcare
The attempt to restrict access to medication abortion by characterizing it as dangerous is a transparent effort to control women's reproductive choices rather than protect their health. The evidence is unequivocal: medication abortion is safe, effective, and essential healthcare. The FDA's rigorous approval process and 25 years of real-world evidence demonstrate that mifepristone and misoprostol are among the safest medications available.
Telemedicine provision of medication abortion has expanded access for women who face geographic, financial, or logistical barriers to in-person care. Research confirms that medication abortion provided via telemedicine is as safe and effective as provision in a healthcare facility. Online-only clinics now account for 8% of all abortions provided within the formal healthcare system, offering flexibility and reducing secondary costs such as transportation, childcare, and missed wages.
The increased use of medication abortion has contributed to an 11% increase in total abortions since 2020, rising to over 1 million procedures annually.
This increase reflects improved access to safe, legal healthcare—not a public health crisis.
Women who cannot access abortion care face dangerous consequences: forced continuation of unwanted pregnancies, increased risk of intimate partner violence, economic hardship, and barriers to education and career opportunities.
States with strict abortion regulations report higher suicide rates among women of reproductive age. Denying abortion is linked to more frequent mental health crises, including suicidal thoughts. Nonetheless, studies indicate that abortion itself does not raise the risk of suicide.
The right to seek individual healthcare outside one's state should never be criminalized. Women must be free to make informed decisions about their reproductive health without government interference, intimidation, or the threat of prosecution. Access to medication abortion is not a luxury or a convenience—it is essential healthcare that allows women to maintain control over their bodies, their futures, and their lives.
Conclusion: Real Protection Requires Real Healthcare Access
The rhetoric of "protecting women" from medication abortion rings hollow when we examine the real dangers women face: intimate partner violence that escalates during pregnancy and is exacerbated by abortion restrictions; systematic dismissal of women's pain and exclusion from medical research; economic discrimination through healthcare costs and the pink tax; denial of reproductive autonomy through refusal of sterilization procedures; and criminalization of interstate travel for legal healthcare.
True protection of women requires ensuring access to comprehensive reproductive healthcare, including safe medication abortion. It requires addressing the gender biases embedded throughout the medical system that lead to inadequate pain management, delayed diagnoses, and dismissal of women's concerns. It requires economic justice that eliminates the pink tax and ensures affordable healthcare. It requires respecting women's autonomy to make their own reproductive decisions, including access to sterilization when they request it. And it requires defending women's constitutional right to travel across state lines to access legal healthcare.
The misuse of medication is not grounds for removing access to healthcare. By that logic, we should ban countless essential medications that occasionally are abused. The real threat to women's health and safety comes not from FDA-approved medications with a 25-year safety record, but from policies that restrict access to essential healthcare, dismiss women's pain and autonomy, and criminalize their constitutionally protected rights.
Women deserve better than a healthcare system that doubts their pain, denies their autonomy, charges them more for essential services, excludes them from research, and criminalizes their healthcare decisions. They deserve evidence-based policies that respect their dignity, autonomy, and right to make informed decisions about their own bodies. That begins with protecting access to safe, effective medication abortion and defending women's fundamental right to comprehensive reproductive healthcare.
*Photos from Wix and FreePik