As conservative US states rush to enact abortion bans following the US Supreme Court’s decision, the fight over reproductive rights in the US is poised to shift to a new battleground: abortion pills.
With little other means at its disposal, US President Joe Biden’s administration is to focus on expanding access to abortion pills for women living in states where the procedure is banned or restricted — while those states and powerful conservative groups are sure to mount legal challenges to prohibit their use.
Hours after the Supreme Court shredded 50 years of constitutional protections for abortion rights on Friday, Biden ordered health officials to ensure that abortion pills are available to American women.
“I will do all in my power to protect a woman’s right in states where they will face the consequences of today’s decision,” he said in a televised address to the nation.
The pills, which can be used without significant risk to terminate a pregnancy up to 10 weeks’ gestation, account for half of all abortions carried out in the US.
Demand is set to soar after 11 states, mostly in the Republican-led conservative South, moved to severely restrict or fully ban abortion, with others set to follow suit.
On Saturday, some advocates rallying outside the Supreme Court in Washington held up posters with instructions on where women can get abortion pills, while others chanted: “My body, my choice.”
Rebecca Gomperts, a Dutch physician who runs Aid Access, an Austria-based organization that provides abortion pills over the Internet, is confident that the situation faced by American women is not as tragic as it was 50 years ago, before the landmark Roe vs. Wade ruling of 1973 that enshrined abortion rights in the US.
“The abortion pills cannot be stopped,” Gomperts said by telephone. “So there is always access to a safe abortion if a woman has an unwanted pregnancy.”
After Friday’s ruling, that might be easier said than done.
The US Food and Drug Administration approved the use of abortion pills two decades ago and last year allowed for them to be prescribed via telemedicine and delivered by mail.
However, their use in anti-abortion states remains a legal gray area and is likely to become a front line in court battles over reproductive rights.
According to the Guttmacher Institute, a research group that supports access to abortion, 19 US states require that abortion pills be physically administered by a clinician, thus prohibiting their delivery by mail.
In states that ban all methods of abortion, women might be prohibited from seeking telemedicine consultations with doctors outside their state or foreign clinicians, such as Gomperts’ group.
In this case, they might have to travel to a state where reproductive telemedicine appointments are allowed and get the medication delivered to an out-of-state address.
However, there is another complication: A medication abortion requires two drugs: A dose of mifepristone is taken to block the hormones that support a pregnancy and then misoprostol is taken 24 to 48 hours later to induce contractions.
This raises a question: Can a woman from an anti-abortion state be prosecuted if she receives the first dose elsewhere, but takes the second dose after returning home?
As liberal states take action to facilitate abortions for women from other parts of the country, there are fears that conservative states might seek to prosecute health workers and advocacy groups involved in those efforts — and even the patients themselves.
Anticipating such plans, US Attorney General Merrick Garland on Friday said that states cannot ban abortion pills, authorized by the FDA, “based on disagreement with the FDA’s expert judgement about its safety and efficacy,” as federal law pre-empts state law.
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