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

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

Topeka, Kan. – Before the birth of her daughter, she spent weeks in bed. Another difficult pregnancy could have been worse because she tried to take care of her little one.

Faced with that prospect, the 28-year-old woman from Texas did what more and more people saw as: She had a friend in another state send her pills she needed to end her pregnancy. She took the pills and went to bed early and described the experience as “quiet” and “peaceful.”

“If people can give birth in birth centers or in their own homes, why can’t people have abortions in their own homes?” said the woman, who spoke on the condition of anonymity because she fears legal reprisals as Texas heads to join several other states in not allowing mail delivery of abortion drugs. “It’s a comfortable thing.”

The COVID-19 pandemic and the nearby Texas ban on abortion have increased interest in obtaining abortion drugs by mail. But with legality in doubt in many states, some people looking to get around the restrictions may not see it as worth the risk. The issue is gaining new urgency as the Supreme Court is due to hear next month in Mississippi’s attempt to undermine Roe v. Wade’s guarantee of the right to abortion.


Some abortion rights advocates worry that whatever state officials and anti-abortion groups promise, people who terminate their pregnancies at home will face criminal prosecution.

“We don’t think people do anything wrong with ordering medication from a website,” said Elisa Wells, co-founder and co-director of Plan C, which provides information on medical abortions. “I mean, this is how guys get Viagra. They order it online, and no one talks about it and asks, is this illegal?”

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

However, people seeking abortion pills often have to navigate various state laws, including drug delivery prohibitions and telemedicine consultations to discuss medication with a health care provider. Until Democrat Joe Biden became president, US government policy prohibited mail delivery across the country.


“We did not want women to use these drugs and have no protection, guidance or counseling,” said Julie Daniels, the Republican senator from Oklahoma and the lead sponsor of her state’s law banning the delivery of abortion drugs by mail. which was suspended amid a legal challenge.

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

Aid Access, which helps women get the abortion pill and covers the costs of those who can’t afford it, says it can’t yet provide data from recent months. There has been a 27% increase in the United States in people seeking abortion pills as states imposed 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 check for the spread of the coronavirus.


Aid Access has a physician based in Europe, Dr. Rebecca Gomperts, providing prescriptions to clients in 32 states that only allow physicians to do so. Grains are mailed from India.

“I don’t think any statewide regulation is going to stop Dr. Gomperts from what she’s doing,” said Kristi Pitney, a nurse-midwife in California and Aid Access provider in that state and Massachusetts.

Indeed, Aid Access defied a 2019 order from the Food and Drug Administration to halt drug distribution in the United States In April, the Biden administration overturned the FDA’s ban on mail delivery of abortion drugs during the pandemic.

The division between democratic and republican states is stark in the St. Louis area. On the Illinois side, Planned Parenthood offers telemedicine counseling and prescriptions by mail. However, Missouri prohibits telemedicine and requires a pelvic exam prior to an abortion, which providers view as unnecessary and outrageous.


“In Missouri, we do not offer medical abortion due to state requirements,” said Dr. Colin McNicolas, chief medical officer of the regional branch.

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

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


“Obviously it would be a lot easier if we got cooperation from the federal government,” said John Sego, legislative director of Texas Right to Life. “There is no magic bullet identified yet for how we approach this kind of post-combat frontier.”

However, Seago says the tougher penalties give prosecutors an incentive to prosecute violators. Montana law, for example, imposes a 20-year prison sentence, a $50,000 fine, or both for anyone mailing pills to a state resident.

Abortion rights advocates have said pregnant women seek telemedicine counseling and abortion pills by mail because they do not want to travel, cannot travel, or cannot arrange leave or childcare.

“Just because someone doesn’t have access to an abortion doesn’t mean they’ll suddenly go into wanting to continue a pregnancy that wasn’t originally desired, right?” Mira Shah, chief medical officer of Planned Parenthood out of New York City, which also performs abortions in Indiana, said.


A person in Ohio who identifies as non-binary said he used an herbal remedy to manage an abortion alone in a dorm room in 2016, before Aid Access launched its site, telling a roommate she had stomach flu. They said they didn’t own a car and didn’t know they could get financial help, and described the Aid Access model as “cool.”

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

New laws in Montana, Oklahoma and Texas say people can’t face criminal penalties for miscarriages. However, these rulings — and assurances from abortion opponents that their goal is not to prosecute people who have terminated their pregnancies — do not comfort some abortion rights advocates.


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

Some abortion rights advocates said prosecutors could also use child endangerment or manslaughter charges against people who have had abortions — or who have had abortions that authorities consider suspicious. They worry that the poor and people of color are especially at risk.

“They can’t get the drugs wherever they are, so they can buy pills from informal networks or websites,” said Melissa Grant, COO of Carafim, which operates clinics in four states and provides abortion drugs in nine states. “But that’s more dangerous in this country than actually taking medication.”



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