WASHINGTON — The future of abortion in the United States is going through the mailbox.
Medical abortion, in which a woman takes two drugs to end an early pregnancy at home, has become the most common method used in the United States during the pandemic, especially after the United States Food and Drug Administration United States has stopped requiring that the prescription be dispensed in a health care facility. rather than delivered directly to a user. International online pharmacies ship them without a prescription at all.
If the Supreme Court overturns Rowe v. Wade says medical abortion could be a game-changer — the last option for women in conservative states who can’t travel elsewhere to end their pregnancies.
“We view medical abortion as a potentially transformative and disruptive technology in the face of these unjust laws being passed,” said Elisa Wells, co-founder and co-director of Plan C, a website that provides research and use information. . medication. “It’s a bit of a safety net, potentially.”
Drugs can be shipped discreetly, in some cases evading detection by those hoping to ban their use. It’s so difficult to track that statistics on the number of so-called self-directed medical abortions — those performed without a prescription or without the advice of a doctor — aren’t well known.
“It will be very different from the pre-Roe era when abortion was illegal in that it’s harder to restrict pills,” said Dr. Daniel Grossman, an abortion provider and director of advancement. new standards in reproductive health at the University of California, San Francois. “It is easier to potentially access it through various channels. And the pills are very safe and effective, unlike other unsafe abortion methods or methods people might have used on their own in the 1960s.”
But just as abortion-rights advocates seek to boost access to medical abortion, anti-abortion groups are focused on enacting additional state restrictions on pills, making drugs the next battleground in the world. the decades-long cultural clash over abortion.
“It’s one of our biggest priorities and it’s certainly something that a lot of states think about a lot more than they did three years ago,” said Katie Glenn, government affairs adviser. at Americans United for Life, a law firm that opposes abortion and advises states on legislation. “We’ve seen a huge increase in pill use during COVID.”
The process of a medical abortion consists of two medications taken in succession. Mifepristone is taken primarily to block the effects of progesterone, a hormone needed to maintain pregnancy. The second drug, misoprostol, is taken a day or two later to generate the cramping and bleeding that mimics an early miscarriage.
A 2015 study showed that at nine weeks pregnant or less, medical abortion was successful 99.6% of the time.
Even so, medical abortion “is not a solution to the problem” of a Supreme Court ruling that undermines abortion rights, Grossman said.
Obstacles include drug costs, shipping delays, potential legal risks, and pregnancies that fall outside the recommended 10-week window for pill use. A medical abortion also takes longer than an in-office procedure and sometimes patients worry that they are not using them properly.
But in states that plan to limit or ban abortion — more than two dozen in the South and parts of the West Mountain have already done so or plan to do so — medical abortion is likely one of the few remaining options.
PlanCPills.org provides convenient options for residents of each state, although in some cases shipping or taking medication may violate local laws.
For example, a patient in Texas – where abortion is banned after fetal heart activity is detected at about 6 weeks gestation – could cross the border to New Mexico and make an appointment with a doctor there. The pills can be shipped to a friend in New Mexico or to a temporary mailbox the patient set up in the state and forwarded to Texas. Or a patient could stay in Texas and purchase the drugs directly from an online pharmacy for $200 to $500.
Established when President Donald Trump took office on a vow to appoint only anti-abortion judges, Plan C was inspired by observing how accessible abortion pills were in other countries, such as Ethiopia, where pharmacies sold them for $7 without a prescription, Wells said.
In the United States at the time, the drug could cost several hundred dollars and required an in-person visit with a doctor and a prescription.
After the FDA dropped the in-person requirement early in the COVID-19 crisis, medical abortions overtook in-clinic procedures as the most common method of abortion in the United States, according to the Guttmacher Institute, a research group that supports abortion. rights.
The impending Supreme Court decision and the decision of states to restrict access to abortion have only increased interest in the drug. Prior to the enactment of the 6-week abortion ban in Texas, the Wells site received approximately 500 visitors a day. After enactment, that figure jumped to 25,000 and has since stabilized at around 2,000, she said.
At Aid Access, perhaps the most well-known medical abortion site, US users are connected to a European healthcare provider and can get a prescription filled at a pharmacy in India. It costs $110 and delivery takes up to four weeks.
Conservative states are already restricting the ease with which abortion pills can be distributed; 19 states have passed laws requiring a medical clinician to be physically present when abortion pills are administered to a patient.
South Dakota is one of them, joining several states, including Texas, Kentucky, Arkansas, Ohio, Tennessee and Oklahoma, where Republicans have moved to further restrict access to abortion pills lately. month.
South Dakota required four trips to a clinic to obtain a medical abortion, but the rule was blocked by the courts. A Texas law prohibits medical abortion after seven weeks of pregnancy, even though the FDA says 10.
Nineteen states prohibit prescribing pills via telehealth appointments or mail delivery, and 32 states limit which medical professionals can prescribe abortion pills, according to Guttmacher.
Mailing abortion pills to a patient is prohibited in Arizona, Arkansas and Texas. Similar bans exist in Montana, Oklahoma and South Dakota, but have been blocked by the courts.
This year alone, more than a dozen states have introduced bans or restrictions on medical abortion, including complete bans on medical abortion, a ban on mailing pills, or a ban on to use telehealth to provide it.
Others focus on banning all self-managed abortions. The practice is illegal in Nevada, South Carolina and Oklahoma, but patients have been arrested in other states as well. More recently, a Texas woman, Lizelle Herrera, was charged with murder for self-administering an abortion. The charges were later dropped and a Texas prosecutor made it clear that she broke no laws.
Abortion opponents encourage states to focus on banning early abortions, when drugs are most often used.
“Some states will only go so far as to ban second and third trimester abortions, making these unavailable in their state. But the majority – over 90% – of abortions take place in the first trimester,” said Kristan Hawkins, president of the activist group Students for Life “We really need to explain to the American people why these abortions are just as horrible as a late abortion.”
Enforcing state medical abortion laws will likely be more difficult, especially when the process takes place online rather than in a clinic or doctor’s office.But proponents of abortion rights nonetheless worry about the chilling effect the laws may have on women who want to end a pregnancy and on health care providers who may feel compelled to report cases. abortion suspects or face their own legal problems.
The EMAA Project, a group that advocates for medical abortion care, is having preliminary conversations with the Biden administration about what can be done to strengthen access, according to the group’s director, Kirsten Moore.
In addition to dropping the requirement for in-person dispensing, the FDA said it will certify pharmacies that wish to dispense medical abortions under strict FDA rules that govern its use.
But states that oppose abortion have already indicated that they plan to issue their own requirements associated with such certification.
Moore’s concern is that any action taken by the Biden FDA to bolster access to medical abortion could be undone by a future Republican president. Still, she hopes small steps can be taken, like pressuring insurers to cover drugs, even as the rise in medical abortions takes the legal and political struggle to new ground.
“There is no obvious one, two, three things to solve the problem,” she said. “We’re going to have to be really creative. And that can only be useful on the margins – which can be significant margins.
Information from The Associated Press is included in this report.