More people are turning to abortion pills by mail, with uncertain legality

Before her daughter was born, she spent weeks in bed. Another difficult pregnancy would be worse as she tried to care for her toddler.

Faced with this possibility, the 28-year-old Texas woman did what a growing number of people considered: she had a friend in another state who sent her the pills she needed to end her pregnancy. She took the pills, went to bed early and described the experience as “calm” and “peaceful”.

“If people can give birth in birthing centers or at home, why can’t people abort at home? said the woman, who spoke on condition of anonymity because she worries about legal retaliation as Texas joins several other states in banning the courier delivery of abortion drugs. “It’s a question of comfort.”

The COVID-19 pandemic and the near-ban on abortion in Texas have led to increased interest in getting abortion drugs by mail. But with the legality in doubt in several states, some people seeking to circumvent restrictions may not consider it worth the risk. The case takes on new urgency with the Supreme Court set to hear arguments next month in Mississippi’s bid to erode the Roe v. Wade decision guaranteeing abortion rights.

Some abortion rights advocates fear that regardless of promises from state officials and anti-abortion groups, people who end their pregnancies at home will face criminal prosecution.

“We don’t think people are doing anything wrong by ordering drugs from an online site,” said Elisa Wells, co-founder and co-director of Plan C, which provides information on medical abortions. “I mean, that’s how men get Viagra. They order it online, and no one talks about it and asks, is it illegal? »

Medical abortions have grown in popularity since regulators began allowing them two decades ago and now account for about 40% of abortions in the United States. The drug can cost as little as $110 to get in the mail, compared to at least $300 for a surgical abortion.

However, people looking for abortion pills often have to navigate different state laws, including drug delivery bans and telemedicine consultations to discuss the drug with a healthcare provider. And until Democrat Joe Biden became president, US government policy prohibited mail delivery nationwide.

“We just didn’t want women using these drugs and having no protection, no advice, no consultation,” said Oklahoma State Senator Julie Daniels, a Republican and the law’s chief patron. his state prohibiting the delivery of abortion drugs through the mail. which is on hold amid a legal challenge.

Plan C saw around 135,000 visits to its website in September, about nine times the number it had before Texas law banning abortion as early as the sixth week of pregnancy went into effect on September 1, Wells said.

Aid Access, which helps women get abortion pills and covers the costs for those who cannot afford them, says it cannot yet provide data for the past few months. It saw a 27% increase in the United States in the number of people seeking abortion pills as states instituted restrictions early in the COVID-19 pandemic, according to a University of Texas study. The biggest increase was in Texas, which had limited access to clinics, saying it was necessary to control the spread of the coronavirus.

Aid Access has a European-based doctor, Dr Rebecca Gomperts, who provides prescriptions to clients in 32 states that only allow doctors to do so. The pills are shipped from India.

“I don’t think state-level regulation is going to stop Dr. Gomperts from doing what she does,” said Christie Pitney, a California nurse-midwife who is the Aid Access provider for this State and Massachusetts.

Indeed, Aid Access defied a 2019 order from the Food and Drug Administration to stop distributing drugs in the United States. In April, the Biden administration lifted an FDA ban on mail delivery of abortion drugs during the pandemic.

The divide between Democratic-leaning and Republican-leaning states is stark in the St. Louis area. On the Illinois side, Planned Parenthood offers telemedicine consultations and prescriptions by mail. Missouri, however, bans telemedicine and requires a pelvic exam before abortion, which providers consider unnecessary and invasive.

“In Missouri, we do not offer medical abortion due to the state requirement,” said Dr. Colleen McNicholas, regional branch medical officer.

Abortion opponents do not expect the FDA’s restriction on abortive drugs to be reinstated under Biden. GOP lawmakers in Arkansas, Arizona, Montana and Oklahoma were already working on new laws to ban mail delivery when the FDA acted. The ban on mail delivery in Texas goes into effect December 2. South Dakota GOP Governor Kristi Noem issued an executive order in September.

Even some abortion opponents think it will be difficult for states to crack down on providers and providers outside their borders, especially outside the United States.

“Obviously it would be a lot easier if we had the cooperation of the federal government,” said John Seago, legislative director of Texas Right to Life. “There’s no silver bullet identified yet on how we’re going to approach this kind of next frontier of combat.”

Still, Seago says tough penalties encourage prosecutors to prosecute offenders. Montana law, for example, imposes a 20-year prison sentence, a $50,000 fine, or both on anyone who sends pills to a resident of the state.

Pregnant women are seeking telemedicine consultations and abortion pills by mail because they don’t want or can’t travel or can’t arrange time off or childcare, abortion rights advocates say .

“Just because someone doesn’t have access to an abortion doesn’t mean they’re suddenly going to want to pursue a pregnancy that wasn’t originally wanted, right? ” said Dr. Meera Shah, chief medical officer of the Planned Parenthood affiliate outside New York, which also performs abortions in Indiana.

A person from Ohio who identifies as non-binary said he used a herbal remedy to self-manage an abortion alone in his college room in 2016, before Aid Access launched his site, telling his roommate that he had the stomach flu. They said they didn’t have a car and didn’t know they could get financial help, and called the aid access model “fantastic”.

“Any way to help pregnant women facilitate their own abortions and experience it in a way that works best for them is a great way to empower a wider range of patients,” they said. , speaking on condition of anonymity because they fear harassment. anti-abortion protesters.

New laws in Montana, Oklahoma and Texas state that people cannot face criminal penalties for having medical abortions. Yet those provisions — and assurances from abortion haters that their goal is not to prosecute people who terminated their pregnancies — do not comfort some abortion rights advocates.

They say about two dozen women have been prosecuted since 2000 over self-administered abortions. An Indiana woman who was sentenced to 20 years in prison for feticide in 2015 for a voluntary abortion spent more than a year behind bars before her conviction was overturned.

Some abortion rights advocates have said prosecutors can also use child endangerment or manslaughter charges against people who have had abortions — or miscarriages that authorities deem suspicious. They fear that the poor and people of color are particularly vulnerable.

“They can’t get medicine where they are, so they can buy pills through informal networks or online sites,” said Melissa Grant, chief operating officer of carafem, which operates clinics in four states and provides abortion medication in nine. “But it’s riskier in this country than taking the drugs.”

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