Demand for medication abortion is surging, setting the stage for new legal battles.
In the hours after the Supreme Court released its decision overturning the legal right to abortion in the United States, nearly 100 requests for appointments flowed into Just the Pill, a nonprofit organization that arranges for patients to obtain abortion pills in several states. That was about four times the usual daily number of appointment requests for the organization, and many came from patients in Texas and other states that quickly halted abortions after the court ruling. Abortion pills, already used in more than half of recent abortions in the U.S., are becoming even more sought-after in the aftermath of Roe v. Wade being overturned, and they will likely be at the center of the legal battles that are expected to unfold as about half the states ban abortion and others take steps to increase access. The method, known as medication abortion, is authorized by the Food and Drug Administration for use in the first 10 weeks of pregnancy. It involves taking two different drugs, 24 to 48 hours apart, to stop the development of a pregnancy and then to cause contractions similar to a miscarriage to expel the fetus, a process that usually causes bleeding similar to a heavy period. Many patients choose medication abortion because it is less expensive, less invasive and affords more privacy than surgical abortions — the pills can be received by mail and taken at home, or anywhere, after an initial consultation with a doctor by video, phone, in person or even just by filling out an online form. The patient must participate in the consultation from a state that allows abortion, even if it simply involves being on the phone in a car just over the border. The IP address of the computer or phone they use allows the clinic to identify where they are. For states that ban all forms of abortion, medication abortion is likely to provide significant enforcement challenges. It is one thing to shut down a clinic; it is much harder to police activities like sending or receiving pills through the mail or traveling to a state where pills are legal to have a consultation and pick them up, legal experts say.
“When people say we’re going back to the days before Roe, there’s no such thing as a time machine — we have a very different pharmaceutical landscape,” said Katie Watson, a constitutional scholar and medical ethicist at the Feinberg School of Medicine at Northwestern University. The abortion laws beginning to take effect in numerous conservative states ban all forms of abortion, including medication abortion. In addition, 19 states already had laws barring using telemedicine for abortion. Texas recently enacted a law prohibiting sending abortion pills through the mail. So groups and some state governments that support abortion rights are mobilizing to help patients obtain the pills in states where they are legal. Since October 2020, Just the Pill has provided more than 2,500 telemedicine consultations with doctors to supply abortion pills by mail to patients in Colorado, Minnesota, Montana and Wyoming. Within a few days, it plans to deploy in Colorado the first of what will become “a fleet of mobile clinics” to park along state borders, providing consultations for medication abortions and dispensing pills, said Dr. Julie Amaon, the organization’s medical director. Called “Abortion Delivered,” the clinic-on-wheels program, which will also provide surgical abortions for patients who prefer it or are too far along in pregnancy for a medication abortion, is designed to reach patients from nearby states like Texas, Oklahoma and South Dakota that quickly outlawed abortion after the court decision, as well as other states like Utah that are expected to ban or sharply restrict abortion.
