Getting Abortion Pills By Mail Is Already More Complicated Than It Seems

Google searches for the term “abortion pills” hit an all-time high on May 3, the day Politico released a leaked draft opinion saying the Supreme Court is likely to overturn Roe v. Wade.

The two-drug regimen of medical abortion, as it is clinically known, has been available since the Food and Drug Administration approved it in 2000. People have been able to get the pills by mail since April 2021, when the FDA approved it. suspended the application of a requirement. that the first pill is administered in person. The agency made this option permanent in December.

But the possibility that a constitutional right to abortion could cease to exist has raised a new set of questions about whether states can legally and logistically prevent residents from getting and taking the pills. The landscape is particularly complicated, two legal experts said, given that the drugs are federally approved.

“Even though the federal government can say, ‘No, we think it’s fine for providers to prescribe this drug,’ states can turn around and say, ‘Sure, but we have the power to regulate what providers are doing. providers, and we want to make it illegal,” said Khiara M. Bridges, a law professor at the University of California, Berkeley.

As for taking abortion pills, it’s likely that “pregnant people could ingest medical abortions without criminal penalties” even if Roe’s is overturned, Bridges said, though “state legislatures may fine-tune those laws.”

But even today, access to medical abortion is expensive and complicated in many states, and regulations vary widely.

Getting abortion pills is “really difficult in much of the country, and it could be legally impossible in much of the country relatively soon,” said Wendy Parmet, director of the Center for Health Policy and Law at Northeastern University.

How Abortion Pills Work

Medical abortion accounted for half of all abortions in the United States in 2020, up from 39% in 2017, according to the Guttmacher Institute, an abortion rights group.

The diet’s first pill, mifepristone, blocks progesterone, a hormone that promotes pregnancy. The second, misoprostol, consists of four pills usually taken 24 to 48 hours later that induce contractions to effectively empty the uterus.

Treatment can be taken up to 10 weeks after the first day of a patient’s last menstrual period. It is about 97% effective in terminating a pregnancy, according to a 2015 review of studies. FDA regulations require that the pills be distributed only by specially certified vendors.

The full plan cost about $560 on average as of 2020, according to a recent study, unless covered by insurance, which varies by state and insurer. An abortion procedure costs about the same in the first trimester.

Medical abortion is different from Plan B, a pill taken within three days of unprotected sex to help prevent pregnancy.

A wide variety of state regulations

Most states have at least one restriction on medical abortion beyond FDA rules, according to the Guttmacher Institute.

Thirty-two states require pills to be prescribed by physicians rather than nurse practitioners or physician assistants. Nineteen require clinicians to be physically present for one or more visits, eliminating mail access. (These are Alabama, Arizona, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, Oklahoma , South Carolina, South Dakota, Tennessee, Texas, West Virginia and Wisconsin.)

Six of those states – Arizona, Arkansas, Louisiana, Missouri, Texas and West Virginia – had also made it illegal to use telehealth for abortion access as of February, according to the Kaiser Family Foundation.

In addition to this, Texas and Oklahoma have passed laws that allow individuals to sue anyone who provides abortion care or helps someone else obtain an abortion after heart activity is detected – about six weeks into a pregnancy.

Aid Access, a nonprofit that provides access to abortion pills by mail, said requests in Texas increased 174% in the three months after the government implemented the six-week ban. ‘State. But in December, an additional Texas law went into effect making it illegal to send abortion drugs into the state.

What happens to access to abortion pills if Roe is canceled?

Overturning Roe – the Supreme Court’s decision is expected in late June – would trigger laws in 13 states banning abortion. Those laws would make it illegal to prescribe or help people obtain abortion pills, but governments might find that part of the ban difficult to enforce, Parmet said.

“It’s going to be very difficult for states to completely block people in their state from accessing medical abortions,” she said. “We have failed to stop people from accessing all kinds of medicines, therapies, illicit drugs.”

An additional complication, the two experts said, is whether state bans can override FDA approval.

“There’s an argument – I don’t know if it’s a winning argument with the current Supreme Court of the United States – that granting federal licenses for up to 10 weeks would nullify and preempt the about a six-week state ban,” Parmet said, referring to Oklahoma and Texas laws.

It’s also unclear whether states would have the legal authority to ban out-of-state doctors from prescribing abortion pills to their residents.

“The argument that red states are going to make is that even connecting to Zoom is the provision of healthcare. So if a provider in New York connects to a Zoom with someone in Texas, then that provider is providing health care to a Texas resident,” Bridges said.

But, she added, “if the easing of restrictions around telehealth in the age of the pandemic persists, then the New York doctor should be free from prosecution.”

Abortion pills are safe

According to a 2018 report from the National Academies of Sciences, complications from medical abortions occur in only a fraction of a percent of patients. A more recent study, published in February, found that about 1% of people who had self-managed medical abortions experienced adverse effects.

However, the pills cause cramping and bleeding which can last for several hours or more. (Bleeding or spotting can last for several weeks.)

Diet safety is less guaranteed if the pills are ordered overseas, which some Texas women have done from unregulated pharmacies in Mexico, NPR and The Texas Tribune reported.

“There are more health risks if you’re taking medications and you don’t know where they come from,” Parmet said. “What we’re really going to have is chaos.”

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