Is buying abortion pills by mail legal?

Everything you need to know about abortion pills and medical abortion after Roe.

Lyudmila Chernetska/Getty Images

The day the Supreme Court overturned Roe v. Wade, throwing the country into chaos over what was once a constitutionally protected right, Google search rules for abortion pills have increased tenfold.

Now that Roe is firmly in America’s rearview mirror, these pills remain misunderstood by many Americans, even though they are poised to become one of the primary ways people end their pregnancies in the states. controlled by Republicans. Here’s what you need to know about abortion pills, their use and legal status in the post-Roe United States, plus how proponents and opponents of abortion rights are already set to clash in their subject.

What are abortion pills?

When people talk about “abortion pills,” they’re usually talking about two drugs: mifepristone and misoprostol. In abortion clinics in the United States, doses of both drugs are typically used to induce what is called a “medical abortion.” Currently, medical abortion is approved in the United States up to 10 weeks of pregnancy.

If you’re imagining an abortion, chances are you’re imagining a “surgical abortion,” which is (predictably) performed using surgical instruments. But medical abortion, which has been available in the United States since 2000, is actually more popular. In 2020, it accounted for 54% of all abortions in the United States, according to preliminary data from the Guttmacher Institute, which tracks abortion restrictions. This is an increase from 39% abortions in 2017.

Why is everyone talking about abortion pills now?

This is probably because medical experts largely agree that a medical abortion can be performed safely at home during the first trimester of pregnancy. The World Health Organization even has a recommended protocol for doing this, without the direction of a medical professional. And thanks to the Internet, people can now order abortion pills directly to their homes.

If you follow the WHO protocol, you’re doing what’s called a “self-directed abortion using pills.” (Doing your own abortion, regardless of method, is known as “self-directed abortion,” but many ways to end a pregnancy are dangerous.) Over the past decade, while a campaign Relentless legislative and legal action by abortion haters has shut down getting a deeply expensive abortion, abortion rights advocates have built a network of resources for people seeking to end their own pregnancies using pills .

Plan C is one such resource. In addition to offering an online guide with state-by-state information on how to obtain abortion pills, with or without the help of medical professionals, the group also orders pills from online pharmacies in order to make sure they are not scams.

“Even in states that unfairly restrict access to abortion care, we know that other routes to medically safe abortion pills are still available,” said Amy Merrill, co-founder of Plan C.

The pills can take up to a few weeks to arrive, Merrill said, and the exact timing can fluctuate. However, she rarely hears about pills stopped by customs.

“Obviously there have been a number of times during the pandemic that mail has been interrupted and flights have been interrupted from overseas and from India – where we know one of the manufacturers is based – and so that has affected shipping times,” she said. “If we talk about online pharmacies, they come from different departments and each has a different supply chain.”

President Joe Biden has said he plans to protect medical abortion. What does that mean?

On Friday, Biden signed an executive order that underscored his administration’s interest in protecting access to medical abortion. In that order, he directed Health and Human Services Secretary Xavier Becerra to prepare, within the next 30 days, a report on how to “protect and expand access to abortion care, including medical abortion”.

However, it is important to note that, in places where abortion is prohibited, medical abortion is not exempt – it too is prohibited. Biden cannot miraculously legalize medical abortion in states that pass blanket abortion bans.

We have already seen a version of this limitation play out under the Biden administration. In a “telemedicine abortion,” a patient can talk to a medical professional, who then sends them abortion pills. The patient then takes the pills on their own. Last year, Biden’s Food and Drug Administration expanded access to telemedicine abortion, allowing people to obtain abortion pills through the pill. However, at that time, 19 states already banned telemedicine abortion.

If I have an abortion at home, do I manage my abortion myself?

Not necessarily.

The pandemic has rewritten the rules around remote health care, and abortion is no different. In recent years, telemedicine abortion has grown in popularity and accessibility, as websites like Hey Jane and Just the Pill have sprung up to help people terminate their pregnancies remotely. However, thanks to telemedicine abortion bans that predated Roe’s fall, telemedicine abortion providers have long been legally barred from offering care in some states. (Plan C’s online guide has some thoughts on this.)

The difference between a “self-directed abortion” and a “telemedicine abortion” is a bit porous, and people may disagree on the distinctions. But a question to ask is: “Does this abortion interact with the American healthcare system? If the answer is no, it’s probably a self-managed abortion, rather than a telemedicine abortion.

This may sound like an academic debate. But as confusion over the legal status of abortion mounts, questions about who performs abortion, and how, will only grow in importance.

Wait, is it now a crime to self-manage your own abortion?

Generally speaking, no. And that was true even before Roe’s downfall, according to Farah Diaz-Tello, legal director of If/When/How, which runs a hotline for people with questions about the legality of self-directed abortion.

“It’s no more legal or illegal than before the Dobbs decision,” Diaz-Tello said, referring to Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe. “But at the same time, we know that the mere existence of this additional scrutiny on abortion care and the suspicion that it has thrown all of that up makes it more likely that a person is going to face criminalization, even in the absence of a law authorizing it.

Only three states—Oklahoma, South Carolina, and Nevada—explicitly have laws against self-directed abortion. But, warns Diaz-Tello, if a prosecutor is interested in bringing charges against people for self-directed abortion, they will find a way to do so. She referred to the case of a woman in Texas who, in April, was arrested for what officials called “voluntary abortion.” Although she was quickly released, after the local attorney said there was no legal basis for prosecution, her name was still splashed all over the news.

Since 2000, more than 60 people have been criminalized for terminating their own pregnancies or helping someone else to do so, according to If/When/How, which also runs a legal defense fund for people facing penal consequences after a self-managed abortion. (The organization will help someone whether or not they use pills to induce an abortion.) After the Roe decision, Diaz-Tello said traffic to the If/When/How website increased by 1000%.

Right now, abortion restrictions tend to punish people who help provide or obtain abortions, not those who have them, and abortion opponents say they want to stick with that. strategy. But although Diaz-Tello said it’s important to know exactly who an abortion restriction is targeting, “the law certainly very often overshoots its mark in this area.”

“The person who terminated the pregnancy is the most visible and accessible person to the system,” Diaz-Tello said. “If they have a complication, they’re the ones to go and talk to the health care providers. They are the ones who will be questioned at the patient’s bedside. They are the ones who will be photographed first in the news.

Merrill knows that even Plan C could face legal consequences simply for providing information about abortion pills.

“We keep coming back to our First Amendment right to share information,” Merrill said. “We believe the moment we are censored and blocked from sharing information about a medically safe option in a certain state, then that is the moment we live in a very different United States. That said, we know, again, the intensity of the politics that this country is involved in right now.

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