After the US Supreme Court shockingly (but predictably) overturned Roe v. Wade last month, interest in abortion medications shot through the roof; on Google Trends, searches for the phrase “abortion pills” increased ten times after the June 24 decision.
Many people are hoping that by “stocking up” on abortion medications now or by relying on out-of-state prescribers in the future that they’ll be able to circumvent abortion bans in their state.
However, while abortion medication is itself quite safe and will remain accessible in many states, there are potential legal and medical risks that everyone should know about.
Here’s our comprehensive, all-in-one guide to abortion medication for a post-Roe America for any queer folks who may need it.
What are abortion medications? Not to be confused with birth control pills, morning-after pills, or Plan B pills, which all prevent pregnancy, abortion medications are intended to terminate a pregnancy many weeks after fertilization; they’ve been FDA-approved for over 20 years, and by some estimates, more than 50 percent of abortions in the US occur through these means.
How do they work? According to Planned Parenthood, the common two-medication abortion method involves first taking one drug that blocks certain hormones and essentially freezes the pregnancy. Up to 48 hours later you’ll take a second pill to, in their words, “empty your uterus.”
The effect is essentially the same as a miscarriage and can last anywhere from four hours to two days.
When can I get a medication abortion?Medication abortions are generally workable up to 11 weeks into pregnancy, although the pills are more effective earlier. Still, with additional doses, medication abortion can be up to 98 percent effective at the 11-week mark.
How do I get it? Previously, abortion medications were legal and available in all US states and territories, although some states passed laws limiting access after a certain number of weeks into a pregnancy.
Patients could obtain aborting medications from almost any doctor and/or clinic that provides abortion services. After the start of the pandemic, many clinics even allow you to order the pills online (after a teleconference with a doctor) and have them shipped to your home.
Now though, things are more complicated.
Are abortion pills legal without Roe v. Wade? After last month’s SCOTUS decision, abortion providers in many states are in chaos. More than a dozen US states had so-called “trigger laws” on the books, outlawing abortion in the event of a federal court ruling allowing such full bans to take effect.
But some of those states now face litigation from abortion providers who argue that those laws are vague, ambiguous, contradictory, or incomplete, leaving the public in the dark about when or if the law may change.
On June 24, the US Justice Department issued a statement holding that “the FDA has approved the use of the [abortion] medication Mifepristone” and thus “states may not ban Mifepristone based on disagreement with the FDA’s expert judgment.”
Many states of course will want to ban abortion medications anyway, and state and federal governments will no doubt end up in court over whether these bans are valid.
But assuming the medication bans go through, then what? No doctor could legally prescribe abortion pills in a state that bans abortion.
However, some abortion activists are promoting alleged legal workarounds to secure prescriptions. For example, the activist group Plan C has published several state-by-state guidelines for pill procuration.
Often these involve setting up a telemedicine appointment with a clinic in a state where abortion is legal and then providing an address in that state where pills will be mailed and then forwarded to you elsewhere.
In some cases, a third party — a friend, family member, or other confidantes — may be instructed to retrieve medication and send it along themselves.
Many of these guidelines were developed before Roe v. Wade was overturned, and were designed to get around limitations put on medication access by hostile lawmakers.
Do these workarounds work? In the broadest sense they do, in that many people obtain medication from out-of-state this way and presumably will continue to do so in the future.
However, there may still be legal dangers involved.
“It’s the prescribers who are most at risk,” says Kirsten Moore, director of the abortion medication access group the EMAA Project. “Those virtual providers, there are a couple who are willing to do this, but many others are saying” they don’t want to participate in mail-forwarding schemes, Moore says.
What if the prescriber never knows? Ignoring the fact that it’s never a good idea to lie to your doctor, Rebecca Wang, a lawyer with the reproductive justice group If/When/How, cautions that this could create a legal conflict between doctor and patient.
Generally, if you go to a doctor, and the doctor prescribes you medication that you obtain legally through a pharmacy, and then you follow that doctor’s orders, “that would eliminate the risk” of prosecution for the patient, Wang says.
This means, yes if you find an out-of-state doctor willing to prescribe to you, you are probably insulated from legal fallout. However, misleading a healthcare provider shifts the potential liability to you instead of the clinician.
Some advocates suggest driving across state lines to a place where abortion is legal before your teleconference with a doctor. Moore says, “That is more legally defensible, but still a little bit of a question mark” if you end up taking the pills in an abortion ban state.
Wang says, “Each provider might have some of their own guidelines–some may want you to take the medicine physically in the state where they practice,” just in case.
Note that while FDA-approved abortion medications are safe and effective, as with any medicine there is a small chance of an adverse reaction. If you go to a hospital, staff might report a suspected medication abortion.
The political element makes these cases unpredictable: Ideologically motivated prosecutors may try to go after doctors and patients if there’s even the tiniest bit of ambiguity in what the law allows, and vicious right-wing lawmakers will doubtless try to push the bounds of their authority with new laws that expand the reach of the anti-abortion statutes in ways that may take years for the courts to reconcile.
“Everyone is trying to do everything they can think of” to secure their reproductive health right now, because “people are scared” and may try anything, Wang says. But, “there are a lot of legal risks that are going understated.”
What about ordering pills online? Many people are just cutting out the healthcare system entirely and ordering abortion pills from overseas pharmacies online and stocking up now for potential future use.
Sites that offer these services are usually based overseas and thus “legally untouchable,” says Moore.
For the buyers, this is almost always illegal, but it’s hard to get caught. “We don’t know of anyone who has been prosecuted just for ordering pills online,” says Wang.
However, you may have little or no idea who you’re buying from, or what they’re really sending you. Some will undoubtedly take the risk and try it anyway, especially those who feel the US legal and medical systems have abandoned them.
The bottom line: The uncertainty and anxiety millions of Americans now feel about their health and safety is of course a big part of the point of these anti-abortion campaigns.
FDA-approved abortion medications are a safe and effective way to terminate a pregnancy up to 11 weeks. There remain some perfectly legal ways to obtain them in the US, although zealous politicians will in the future likely attempt every roadblock to keep them out of the hands of patients, and there’s always the risk they’ll try to prosecute illegally just as a scare tactic.
Because the health and safety of millions of people is on the line, you may know or hear about people who will try any number of quasi-legal bids to obtain abortion pills. While these may work, all of them run at least some danger of prosecution in abortion ban states; be sure you know all of the ramifications of your decision before you act.
If you have questions about the legalities of abortion access, head to reprolegalhelpline.org for counseling about the law in your state.
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