The next battle over abortion access will be over the pills

SIOUX FALLS, SD — It took two trips over state lines, navigating icy roads and a patchwork of state laws, for a 32-year-old South Dakota woman to get abortion pills last year.

For abortion seekers like her, such trips, along with pills sent through the mail, will grow in importance if the Supreme Court acts on its leaked draft opinion that would overturn the landmark Roe v. Wade and would allow individual states to ban the procedure. The woman, who spoke on condition of anonymity because she feared for the safety of her family, said the abortion pills enabled her to end an unexpected, high-risk pregnancy and remain dedicated to his two children.

But anti-abortion activists and politicians say these cross-border trips, remote doctor consultations and pill deliveries are what they will try to stop next.

“Medical abortion will be where abortion access is decided,” said Mary Ziegler, a professor at Florida State University College of Law who specializes in reproductive rights. “It will be the battlefield that will decide the applicability of abortion bans.”

The use of abortion pills has increased in the United States since 2000, when the Food and Drug Administration approved mifepristone, the main drug used in medical abortions. More than half of abortions in the United States are now performed with pills rather than surgery, according to the Guttmacher Institute, a research group that supports abortion rights.

Two drugs are needed. The first, mifepristone, blocks a hormone needed to maintain pregnancy. A second drug, misoprostol, taken one to two days later, empties the uterus. Both drugs are available as generics and are also used to treat other conditions.

Last year, the FDA lifted a longstanding requirement that women obtain abortion pills in person. Federal regulations now also allow mail to be delivered nationwide. Despite this, 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.

These measures have stimulated online services that offer information on obtaining abortion pills and consultations to obtain a prescription. After the South Dakota woman discovered the state’s only abortion clinic couldn’t schedule her for a medical abortion in time, she found an online service, called Just The Pill, who advised her to travel to Minnesota for a telephone consultation with a doctor. . A week later, she returned to Minnesota for the pills.

She took the first almost immediately to her car, then cried as she drove home.

“I felt like I lost a pregnancy,” she said. “I love my husband and I love my kids and I knew exactly what I had to say goodbye to and it was a really awful thing to do.”

In addition to crossing state lines, women can also turn to international online pharmacies, said Greer Donley, a professor specializing in reproductive health care at the University of Pittsburgh School of Law. Some women also have prescribed pills passed across states without restrictions.

“It allows someone to have an abortion without the direct role of a provider. It’s going to be much harder for states to control access to abortion,” she said, adding, “The question is how is that going to be enforced?

Abortion law experts say it’s 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 prevails over the laws of the conflicting states,” said Laura Hermer, a professor at the Mitchell Hamline School of Law in St. Paul, Minnesota. “There is no doubt that the FDA has the power to regulate the drugs used. The question is whether a state can make a viable and winning argument that for public health purposes it should further regulate access to the relevant drugs.

Hermer said she doesn’t think there is a valid public health reason because published evidence indicates the drugs are “exceptionally safe.” But if the Supreme Court overturns Roe v. Wade and that a state grants embryos and fetuses full human rights “then all bets would be off”.

The regional Planned Parenthood organization that includes South Dakota does not believe it can legally send abortion pills to patients there.

Telemedicine providers must follow the laws of the state where the patient is located, said Dr. Sarah Traxler, chief medical officer for Planned Parenthood North Central States in St. Paul. She acknowledged that some organizations disagree. “But,” she added, “we don’t feel like we have the freedom to ship pills from Minnesota to other places in the country where it’s illegal to offer medical abortion.”

Sue Leibel, director of state policy for Susan B. Anthony List, a prominent anti-abortion organization, acknowledged that medical abortions have “slipped” on Republican lawmakers in the state.

“It’s a new frontier and states are struggling with enforcement mechanisms,” she said, adding, “The advice I always give – if you close the front door, the pills go enter through the back door.”

Leibel argued that women should not be prosecuted for seeking abortions, consistent with a long-held principle of many abortion opponents. She suggested that the next target for state law enforcement should be the pharmacies, organizations and clinics that supply the abortion pills. She also said abortion rights opponents should focus on electing a presidential candidate who will work to overturn the FDA decision.

The FDA said scientific review supported expanding drug access and complications were rare. The agency has reported 26 deaths associated with the drug 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 going to greater lengths to obtain the procedure, Donley, the law school professor, worried that state lawmakers were turning their attention to women who receive the pills.

Indeed, a Louisiana House committee on Wednesday introduced a bill that would make abortion a felony of homicide for which a woman terminating her pregnancy could be charged, as well as anyone assisting her.

“Many anti-abortion lawmakers might realize that the only way to enforce these laws is to sue the pregnant person themselves,” Donley said.

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Associated Press writer Steve Karnowski contributed from St. Paul, Minnesota.

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