Roe v Wade

Medication abortion is common, effective, and under attack by Republicans

Most abortions in the US and overseas involve pills that can be taken at home, but GOP lawmakers have launched a new war on drugs, Alex Woodward reports

Medication abortion is by far the most common form of abortion care in the US, accounting for nearly 60 per cent of all procedures.

Abortion drugs were approved for use by the US Food and Drug Administration in most cases up to 10 weeks of pregnancy in 2000. A two-drug regimen of mifepristone and misoprostol – drugs that are available over the counter in some countries – is overwhelmingly safe and effective.

Last year, the FDA permanently lifted the in-person requirement for medication abortion prescriptions, allowing patients to access the drugs via telehealth appointments and online pharmacies so patients can take the drugs at home.

But within 2022 alone, Republican legislators across the US filed more than 100 bills to restrict their availability and distribution, or to ban them altogether, drawing a new line in the GOP’s war on abortion as the US Supreme Court strikes down constitutional protections for abortion care and hands control of abortion rights to anti-abortion state lawmakers.

The drugs also are commonly used to treat miscarriages, which occur in roughly one in every 10 pregnancies. Mifepristone and misoprostol are the only drugs recommended by the American College of Obstetricians and Gynecologists to treat an early pregnancy loss.

Advocates have warned that restrictions on access to the drugs could lead to dangerous health consequences for women seeking care. Patients in Texas already are reporting that their pharmacies will not fill their misoprostol prescriptions.

Nineteen states require a clinician providing medication abortion to be physically present when the drugs are administered, effectively banning telemedicine appointments to prescribe the medication.

Patients in those states must still go through the same obstacles – in-person appointments, waiting periods, long-distance travel – as they would for procedural abortions, and many states are also making it illegal to obtain the medication by mail.

President Joe Biden has instructed health officials “to identify all ways to ensure that mifepristone is as widely accessible” following “threats from state officials saying they will try to ban or severely restrict access to medication for reproductive health care,” according to the White House.

US Attorney General Merrick Garland said the US Department of Justice stands “ready to work with other arms of the federal government that seek to use their lawful authorities to protect and preserve access to reproductive care.”

“In particular, the FDA has approved the use of the medication Mifepristone,” he said. “States may not ban Mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy.”

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Democratic Senator Tina Smith has introduced a bill to protect access to medication abortion in states where the right to an abortion is still protected.

Senator Smith’s Protecting Access to Medication Abortion Act would codify FDA guidelines to ensure patients can access medication abortion by telehealth appointments and mail-order pharmacies.

“Extremist Republican” efforts to eliminate medication abortion “are undermining the ability of women to access proven, safe, and effective reproductive health care,” the senator said in a statement.

“By attacking and undermining access to a safe and effective medication, Republicans are saying that government – not women, not their health care providers – should control the health care that doctors provide women,” she said. “We need to fight back against Republican efforts to chip away at women’s reproductive freedoms.”

Abortion rights activists took abortion drugs outside the US Supreme Court in December 2021 as justices heard oral arguments in a Mississippi case that could determine the fate of abortion access for millions of Americans.

She said the bill aims to protect “what remaining access will exist to reproductive health care after abortion is criminalised in many parts of this country.”

The legislation is among several proposals from members of Congress to combat anti-abortion laws and protect abortion access in the wake of the Supreme Court’s decision.

The White House and congressional Democrats are calling on tech companies to stop maintaining or selling sensitive health data and location information from apps that could be acquired by anti-abortion activists and law enforcement agencies to prosecute providers in states where abortion is expected to be outlawed.

A group of Senate Democrats has also urged Google to block misleading search results and ads on the platform that direct users towards “fake” abortion clinics and so-called “crisis pregnancy centres,” nonmedical facilities intended to dissuade people from seeking an abortion.

Roughly one in four women in the US will have an abortion by age 45, according to an estimate from the Guttmacher Institute, a reproductive health research group. The group estimates that 18 per cent of pregnancies in the US end in induced abortions.

Most abortions in the US are within the first trimester, according to the US Centers for Disease Control and Prevention. In 2019, nearly 93 per cent of all abortions were performed before the 13th week.

Medication abortion typically is prescribed after patients make an appointment with an abortion clinic, where they receive medication to be taken within the course of 72 hours.

In states that have allowed telehealth appointments for abortion care within the first 10 weeks of pregnancy, like California and New York, physicians and virtually prescribe the drugs and patients can receive them in the mail, allowing people to manage their abortions from the comfort of their own home.

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Recent polling finds that, despite the widespread availability and use of abortion drugs, nearly half of voters do not know that it is possible to “safely and legally end a pregnancy at home with prescription medication,” suggesting that the public’s understanding of how abortions are performed is extremely out of date or obscured by anti-abortion talking points, while “many are just beginning to learn about abortion medication.”

“Every single fact about early abortion medication tested in this survey improves the medication’s favorability,” according to survey authors with left-leaning think tank Center for American Progress, which noted that the “biggest mover” for changing public opinion is explaining that the FDA supported the medication’s use.

A two-drug regimen of mifepristone and misoprostol tablets is the most common form of abortion care in the US. Misoprostol also is used to treat miscarriages.

But Republican state legislators have introduced several measures to criminalise medication abortion, including a bill in Missouri that would classify the distribution of abortion drugs as felony drug trafficking, and another measure in Tennessee criminalises the distribution of medication abortion by mail, punishable up to 20 years in prison. That bill was signed into law.

Model legislation proposed by National Right to Life – the nation’s largest anti-abortion group – would criminalise “giving instructions over the telephone, the internet, or any other medium” or “hosting or maintaining a website, or providing internet service, that encourages or facilitates efforts to obtain an illegal abortion” or “offering or providing illegal ‘abortion doula’ services” and “providing referrals to an illegal abortion provider.”

The group – which is promoting the legislation to Republican state lawmakers – suggests outlawing the manufacturing and distribution of medication abortion as a form of “trafficking”.

Attorneys for the group argue that “the whole criminal enterprise needs to be dealt with to effectively prevent criminal activity, so RICO-style laws were adopted” – referencing the Racketeer Influenced and Corrupt Organizations Act, which has been used to prosecute organised crime and the mafia.

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Following the Supreme Court’s oral arguments in Dobbs v Jackson Women’s Health Organization and the leaked draft opinion signalling the conservative majority’s intention to overturn Roe, mutual aid organisers, abortion rights advocates and overseas aid groups mobilised to help connect patients to medication abortion.

Austria-based Aid Access prescribes medication abortion to people across the US, circumventing state laws criminalising US-based providers.

Advocacy group Plan C, which offers instructions on how to access medication abortion, also launched a New York City subway campaign providing information about self-managed abortions.

“We don’t want people to be alone or confused about their legal rights or possible legal risk if they are thinking about self-managing their abortion,” said Rebecca Wang, legal counsel at reproductive health justice group If/When/How, which partnered with Plan C.

“Criminalisation of pregnancy outcomes thrives when abortion is restricted, stigmatised, and isolated, and the helpline is a resource to provide people with the support and legal information they need to make fully informed decisions about what is best for them and their families.”

This story was originally published on 24 June and has been updated

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