Last year, a 32-year-old South Dakota woman took two trips across state lines, navigating snowy roads and a patchwork of state laws, to take abortion pills.
For abortion seekers like her, such trips, with pills sent through the mail, will grow in importance if the Supreme Court follows up on the opinion of its leaked draft that the landmark Roe v. Wade’s decision and allow individual states to restrict. Process.
The woman, who spoke on condition of anonymity because she was concerned for the safety of her family, said the abortion pills allowed her to terminate an unexpected and high-risk pregnancy and remain devoted to her two children. Gave.
But anti-abortion activists and politicians say they will try to stop further cross-border trips, remote doctor consultations and pill delivery.
“Drug abortion will be where access to abortion is decided,” said Florida State University College of Law professor Mary Ziegler. “It’s going to be the battlefield that decides how enforceable the abortion restrictions are.”
The use of abortion pills in the US has been on the rise since 2000 when the Food and Drug Administration approved mifepristone — the main drug used in the drug abortion. More than half of American abortions are now performed with pills instead of surgery, according to the Guttmacher Institute, a research group that supports abortion rights.
Two drugs are required. The first, mifepristone, blocks a hormone needed to maintain pregnancy. Another medication, misoprostol, taken one to two days later, causes the uterus to empty. Both drugs are available as generics and are used to treat other conditions as well.
The FDA last year removed a long-standing requirement that women personally pick up abortion pills. Federal regulations now also allow for nationwide mail delivery. Nevertheless, 19 states have passed laws that require a physician to be physically present when giving abortion pills to a patient.
South Dakota is one of them, joining several states including Texas, Kentucky, Arkansas, Ohio, Tennessee and Oklahoma, where Republicans have moved in recent months to restrict access to abortion pills.
Those moves have boosted online services that provide information about obtaining abortion pills and counseling to obtain prescriptions. After the woman in South Dakota found that the state’s only abortion clinic couldn’t schedule her on time for a drug abortion, she found an online service called Just the Pill, which advised her to go to Minnesota for a phone consultation with a doctor. . A week later, she came back to Minnesota for pills.
She took the first car in her car almost immediately, then cried as soon as she left the house.
“I felt like I had lost the pregnancy,” she said. “I love my husband and I love my kids and I knew exactly what to say goodbye and it was a really terrible thing.”
In addition to crossing state lines, women can also turn to international online pharmacies, said Greer Donnelly, a professor specializing in reproductive health care at the University of Pittsburgh Law School. Some women even prescribed pills are being forwarded through the states without any restrictions.
“It allows anyone to have an abortion without the direct role of a provider. It would be very difficult for states to control abortion access,” she said, “the question is, how is this going to be enforced?”
Abortion law experts say it remains an unresolved question whether states can restrict access to abortion pills in the wake of the FDA’s decision.
“The general rule is that federal law precedes conflicting state law,” said Laura Hermer, a professor at the Mitchell Hamline School of Law in St. Paul, Minnesota. “There is no question that the FDA has a reasonable authority to regulate drugs used in drug abortion. The question is whether a state can make a viable, winning argument that, for public health purposes, it should have access to relevant drugs. needs to be further regulated.”
Hermer said he does not think there is any valid public health reason because the published evidence is that the drugs are “extraordinarily safe.” But if the Supreme Court struck down Roe v. Wade and a state gives full rights to embryos and fetuses as people “then all bets will be off.”
The Planned Parenthood regional organization that includes South Dakota does not believe it can legally send abortion pills to patients there.
Telemedicine providers must comply with the laws of the state where the patient is, said chief medical officer of Planned Parenthood North Central States in St. Sarah Traxler said. She acknowledged that some organizations disagree.
“But,” she added, “we don’t feel like we have the freedom to send pills from Minnesota to other places in the country where providing drug abortion is illegal.”
Susan B. Sue Leibel, state policy director for Anthony List, a leading anti-abortion organization, acknowledged that drug abortion has “ripened” on Republican state lawmakers.
“It’s a new frontier and states are grappling with enforcement mechanisms,” she said, “the advice I always give — if you close the front door, the bullets are going to come in the back door.”
In keeping with the long-standing doctrine of many abortion opponents, Leibel said that women should not be prosecuted for seeking abortions. She suggested that the next target for state enforcement should be pharmacies, organizations and clinics that provide abortion pills. She also said that abortion-rights opponents should focus on choosing a presidential candidate who would serve to reverse the FDA’s decision.
The FDA said a scientific review supported widespread access to the drugs and found that complications were rare. The agency has reported 26 drug-related deaths since 2000, although not all of them can be directly attributed to the drug due to existing health conditions and other factors.
However, with new legal battles on the horizon and abortion seekers seeking to get the procedure done, law school professor Donnelly worried that state lawmakers would turn their attention to women who get the pills.
Indeed, a Louisiana House committee on Wednesday introduced a bill that would make abortion a homicide offense for which a woman who terminated her pregnancy could be charged, as well as anyone helping her.
“Many anti-abortion legislators may feel that the only way to enforce these laws is to prosecute the pregnant person themselves,” Donnelly said.
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