Friday’s decision by the Fifth Circuit to halt telemedicine delivery of the abortion drug mifepristone and require in-person dispensing was hailed as an important win by pro-life organizations — at least, until the Supreme Court temporarily put that ruling on hold. But while the ruling was a positive step toward protecting the unborn — and protecting women from being unwittingly administered abortion drugs by abusers — it is insufficient.
Shortly after the Fifth Circuit issued its ruling, an article in Ms. Magazine pointed out that an international network of mail-order abortion pill providers already exists and is “ready to ramp up services.”
During the nearly half-century when Roe v. Wade was the law of the land, most of the pro-life movement in the U.S. focused on enacting incrementally protective laws at the state and federal levels, while supporting crisis pregnancy centers and demonstrating outside abortion clinics in their local communities. Since the 2022 Dobbs decision overturned Roe, it has become increasingly important for leaders in the pro-life movement to increase their focus on the international context for two reasons. First, as individual states face unique challenges both legally and practically, there are useful lessons to be drawn from similar situations abroad. And second, it is essential to understand how the international pro-abortion movement has positioned itself to make abortion universally accessible, regardless of legality, with assistance from multilateral agencies, governments, and other donors.
The U.S. was significantly slower to adopt abortion by pills than other countries. Regulations issued by the Food and Drug Administration (FDA) provided safeguards in the event of complications, but they also imposed logistical and operational requirements comparable to those of surgical procedures.
Three events changed everything: the 2020 COVID-19 pandemic, the 2021 lifting of in-person dispensing requirements by the FDA, and the 2022 Dobbs decision. During the COVID lockdowns, temporary allowances were made for remote telehealth abortions, which paved the way for the FDA’s decision to permanently change its policy. Then, when the Supreme Court overturned Roe, telehealth became a way for people in states with strong pro-life laws to obtain abortion pills from states with fewer abortion restrictions.
What many in the U.S. do not know is that this playbook has precursors in other global regions, especially in Latin America, where abortion was heavily restricted and remains so in many countries to this day. Decades ago, women in Brazil discovered that the widely available gastric ulcer drug misoprostol could be used to induce abortions, and feminist networks across the region spread information and guidance, often through hotlines.
In 2014, the World Health Organization (WHO) issued a bulletin clarifying that while it had been conflating the “safety” of abortion with its legality, “the widespread informal use of misoprostol has added a layer of complexity to the concept of ‘safety.’”
Influenced by the global abortion lobby, guidance from the WHO has moved steadily in the direction of prioritizing access to abortion over “safety,” and ensuring the ubiquity of the abortion drugs mifepristone and misoprostol by including them in essential medicines lists while removing caveats insisting on medical supervision.
During the COVID-19 pandemic, the WHO declared abortion an essential service and encouraged expanded use of telemedicine, but even before the pandemic, the WHO issued a guideline arguing that “self-care” approaches had the potential to address unmet needs, such as “self-managed medical abortion in countries where abortion is illegal or restricted.”
All of this is why, in 2026, websites exist, targeted at a U.S.-based audience, to offer abortion pills from overseas, ranging from services run by well-known feminist activists to highly dubious-looking online pharmacies, all proclaiming that they operate in line with WHO guidance.
The WHO’s guidance is not limited to the technical use of abortion pills or its increasingly capacious definition of what kind of abortion can be considered “safe.” In concert with other UN agencies and expert groups, it relentlessly pressures countries to liberalize their abortion laws, including by restricting the conscience rights of health care providers.
During the pandemic, conservatives in the U.S. became concerned by a draft WHO pandemic preparedness treaty that could be used to limit freedom of expression under the label “misinformation.” Since then, the WHO has conducted a scoping review to identify ways to regulate social media platforms to limit misinformation in the “reproductive health” space. This would include both censoring pro-life content that it deems to be “antichoice misinformation” and preventing platforms from restricting the direct advertisement of illicit products and services — such as abortion drugs, where illegal.
Anyone in the U.S. who has had to click a button to accept cookies when visiting a website should not be naïve to the effects that foreign regulations (in this case, the European Union) can have on their online experience.
The pro-life fight continues at the local, state, and federal levels, and there’s plenty to do at each. But now we cannot ignore the international context, as it is the site of important lessons from the past and important battles in the future.
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Rebecca Oas is the Director of Research for the Center for Family and Human Rights (C-Fam) in Washington, D.C. She earned her doctorate in Genetics and Molecular Biology at Emory University with expertise in global maternal and child health and family planning.
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