The most significant change in the abortion landscape may not be the looming Supreme Court opinion in Dobbs v. Jackson Women’s Health Organization, but a pill that arrives by mail and can be taken at home.
Chemical abortion has emerged as the next front in the battleground over pregnancy termination, drawing renewed focus after Monday’s leaked Supreme Court draft signaling that the 1973 Roe v. Wade ruling could be overturned.
“Everybody has a post-Roe, post-Dobbs plan, and for corporate abortion, it’s chemical abortion pills,” said Kristi Hamrick, policy strategist for Students for Life of America.
The two-drug process was used to end 54% of pregnancies in 2020, representing the first time that medication abortions outnumbered surgical procedures, according to the pro-choice Guttmacher Institute in a February report.
That trend is expected to accelerate in the aftermath of the Supreme Court’s anticipated decision allowing states to enact greater restrictions on abortion, which could come as early as next month. Pro-choice advocates are pushing to increase access to the pill.
“With a draft decision that would decimate access to abortion for half the nation, there is now even more urgent need for access to the abortion pill, whether over-the-counter, by advance provision, or through telemedicine across state lines,” tweeted Dr. Daniel Grossman, a professor and obstetrician at the University of California San Francisco.
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The Biden administration has done its part. Last year, the Food and Drug Administration eliminated the requirement for the pills to be dispensed in person, allowing them to be prescribed via telehealth and delivered by mail, citing the COVID-19 pandemic.
In December, the FDA said it would move to make the temporary lifting of restrictions permanent for mifepristone, citing the need to “reduce [the] burden on patient access and the health care delivery system and to ensure the benefits of the product outweigh the risks.”
The first drug, mifepristone, stops the progress of the pregnancy by blocking progesterone. The second drug, misoprostol, causes “cramping and bleeding to empty your uterus,” and lasts about five hours, said Planned Parenthood’s explainer.
In its report, Guttmacher said the increased use “powerfully illustrates that medication abortion has gained broad acceptance from both abortion patients and providers.”
“It also underscores how central this method has become to US abortion provision, thanks to its track record of safe and effective use for more than two decades,” said the Guttmacher analysis. “As medication abortion has become the most common method of abortion, there is still the potential to further increase access — which is why the method has become a main target of anti-abortion politicians and activists seeking to restrict care.”
Indeed, the debate over chemical abortion has played out for years in state legislatures. Nineteen states now require the pills to be administered by a clinician, while 32 states require those giving the medication to be physicians.
Pro-life advocates cite several reasons for medical supervision. For one, the pills are effective until about 10-11 weeks’ gestation, but it’s can be difficult to determine how far a pregnancy has advanced without an in-person exam.
That cutoff date means that the pills are unlikely to replace surgical abortion. About 6% of abortions in 2019 were performed at 14-20 weeks’ gestation, according to the Centers for Disease Control and Prevention.
In addition, the pills carry risks in the case of ectopic pregnancies, which also cannot be detected without an in-person exam.
“Some things can’t be diagnosed over the internet, like how far along the woman is in her pregnancy, or an ectopic pregnancy that could kill her,” said Mallory Carroll, spokesperson for the pro-life Susan B. Anthony List. “In England, the health commissioner tried to end ‘pills by post’ for reasons like these. We’re very concerned and working with state and federal allies to put safeguards in the law.”
Then there’s the risk of infertility for the 15% of women with an Rh negative blood type.
That includes Ms. Hamrick, who had RhoGAM vaccines during her four pregnancies to avoid forming antibodies that can “attack future pregnancies,” she said.
A November study by the pro-life Charlotte Lozier Institute found that the “rate of abortion-related emergency room visits following a chemical abortion increased over 500% from 2002 through 2015,” while the study population increased during the same period from 4.4% to 34.1% of total abortions.
Tessa Longbons, Lozier senior research associate, said that chemical abortions have four times the complication rate of surgical procedures.
“Chemical abortion really is the new back-alley abortion,” said Ms. Longbons. “It’s yet another example of the abortion industry prioritizing abortion above all else.”
She also cited the risk of women being coerced into taking pills obtained by mail, saying there have been examples of “abusive boyfriends giving these drugs to women against their will,” as well as the increased risk of the pills being used by human traffickers.
“We already know there’s a connection between abortion and trafficking,” said Ms. Longbons. “We did a review of some of these websites that were illegally selling abortion pills online, and a lot of them were offering bulk discounts. There’s no good reason for your average person to want to buy a bulk order of abortion-inducing drugs.”
NARAL Pro-Choice America argued in a fact sheet that the drug is safer than many commonly used medications, including Tylenol. Ms. Longbons and Sen. Cindy Hyde-Smith, Mississippi Republican, have disputed this.
“President Joe Biden would do well to ‘follow the science’ and hit the pause button on mail-order abortion in America, recognizing the very real threat it poses to women’s health and safety,” they said in a March 8 op-ed in Newsweek.
If the Supreme Court follows through and overturns Roe, the debate over chemical abortion is likely to intensify in the legislatures as the debate moves to the states.
“I think we’ll certainly see more states working to put these protections back in place, and then other states rolling back protections and making them even more available,” said Ms. Longbons. “It’s a growing issue and will continue to be.”
Certainly the pro-choice movement will be there.
“Abortion pills may be a mitigation strategy to improve access to safe care for some, but they’re not a solution for the dismantling of basic human rights,” tweeted Dr. Grossman.