With the annulment of Roe v. Wade, many of the most intense battles over abortion access will involve sending pills to Republican-run states.
Some pregnant women from these states will travel to states where abortion remains legal. But commuting can be expensive and time-consuming, making it especially difficult for low-income workers.
That’s why both sides of the abortion issue are now gearing up for a protracted fight over so-called medical abortion – and specifically over whether women who live in red states will be able to ordering abortion pills through the mail, even though it’s illegal. Abortion rights advocates hope to protect courier services from legal challenges and try to spread the message that medical abortion is both safe and effective. Abortion opponents are considering how to prevent the mail from becoming a loophole that undermines their newly created bans.
Today’s bulletin looks at three different areas where this problem is likely to play out.
1. Access to help
In 2018, Dr. Rebecca Gomperts, a Dutch doctor, founded a group called Aid Access to help women in countries where abortion is illegal order pills by post. With many US states now banning abortion, Aid Access has new relevance in the US: after Texas enacted a tough abortion law last year, for example, Aid Access has seen a wave of requests from Texas.
To receive pills, women contact a European doctor through the Aid Access website. Then a the doctor will often fill the prescription using a pharmacy in India, which will send the pills by post. They usually arrive in one to three weeks and can be taken safely up to the 12th week of pregnancy.
Ordering the pills through Aid Access costs around $110, with discounts available for poorer women.
Gomperts told us she believes Aid Access is not in legal danger because it follows the laws in Austria, where it is based. “I practice in accordance with the law and all medical ethics guidelines,” she said.
Pro-choice and pro-life advocates agree that cracking down on the sending of abortion pills is difficult. “It’s a difficult issue,” said James Bopp, lead advocate for the National Right to Life Committee. Elisabeth Smith of the Center for Reproductive Rights said, “Even the federal government has no enforcement power against an entity that is entirely outside the United States”
But Smith added that the situation could be different for women who take the pills: they could be in legal danger in some states. Texas, for example, requires a woman seeking an abortion to visit a clinic twice, in part to restrict the use of the pill. A woman who took abortion pills in Texas would violate that law, and Smith and other experts believe prosecutors could bring such a case, especially in the rare cases where women have had complications requiring medical attention. doctor.
One question is how law enforcement officials will try to stop the delivery of pills in the majority of cases. Pharmacies, of course, do not label their packages as containing abortion pills.
(For the Aid Access story: Gomperts has been trying to make abortion accessible for more than two decades, and Emily Bazelon featured her in The Times Magazine in 2014.)
2. Foreign pharmacies
Some foreign pharmacies also ship abortion pills even without a doctor’s prescription. They usually sell generic versions of the drugs mifepristone and misoprostol which were produced in India.
Plan C, a group that helps women seeking to obtain pills by mail, has published lists of pharmacies whose pills the group considers reliable. “We had them analyzed in the lab and they were the real thing,” Plan C co-founder Elisa Wells told us. The pills typically cost between $200 and $500.
Take a Taking medication without the help of a nurse or doctor is obviously not an ideal situation, but some women may decide that they have no other choice. Plan C also publishes medical and legal information about the pills, and a group called M+A operates a hotline for questions about self-directed abortions or miscarriages.
As with pills obtained through Aid Access, women in some states may face legal risks using an overseas pharmacy. Three states — Oklahoma, Nevada and South Carolina — have laws against self-directed abortion, Wells noted.
3. Forwarding mail
A third option is to get a mailbox in a state where abortion is legal and work online with a health care provider in that state. The supplier can send the pills to the mailbox, and the company that manages the mailbox can then deliver them to a woman’s home in a state where abortion is prohibited.
This process involves several steps. Still, Wells said, it’s one of the cheapest and most convenient options for many women. It also involves some of the same legal vulnerabilities as the other options here.
Bopp, the anti-abortion lawyer, said he hopes the federal government will eventually find ways to crack down on the shipping of abortion pills from state to state. But that won’t happen while President Biden is in power, he added.
(This Times Opinion video explains how a Texas woman used the letterbox approach. It meant she didn’t have to take time off work and could induce abortion in the privacy of his home.)
The bottom line
More than half of legal abortions in the United States are already performed using pills, up from virtually none in 2000. This proportion will almost certainly continue to rise, and a significant number of illegal abortions using pills also seem likely in Republican-led states. Increasingly, the future of abortion – and the political struggle around it – will revolve around medical abortion.
Related stories: Kansas will vote on abortion next week. And in some states where abortion remains legal, wait times have recently increased, due to women coming from states where it is now illegal.
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