The day the Supreme Court overturned Roe v. Wade, plunging the country into chaos over what was once a constitutionally protected right, Google search rules for abortion pills increased tenfold.
Now that Roe is firmly in the United States’ rearview mirror, these pills remain poorly understood by many Americans, even as they are poised to become the one of the main ways for people to end their pregnancies in Republican-controlled states. Here’s what you need to know about abortion pills, how they’re used, and their legal status in a post-Roe United States—as well as how as abortion-rights supporters and opponents are already prepared to clash over them.
What are abortion pills?
When people talk about “abortion pills,” they’re usually talking about two drugs: mifepristone and misoprostol. In U.S. abortion clinics, doses of these two drugs are typically used to induce what’s known as a “medication abortion.” Right now, medication abortion is approved for use in the United States up through 10 weeks of pregnancy.
Chances are, if you picture an abortion, you’re picturing a “surgical abortion,” which is (predictably) conducted using surgical implements. But medication abortion, which has been available in the United States since 2000, is actually more popular. In 2020, it accounted for 54 percent of all U.S. abortions, according to preliminary data from the Guttmacher Institute, which tracks abortion restrictions. That’s up from 39 percent of abortions in 2017.
Why is everybody talking about abortion pills now?
That’s probably because medical experts widely agree that a medication abortion can be safely performed at home during the first trimester of pregnancy. The World Health Organization even has a recommended protocol for doing so—without the direction of a medical professional. And thanks to the internet, people are now able to order abortion pills directly to their homes.
If you follow the WHO protocol, you’re doing what’s known as a “self-managed abortion using pills.” (Performing your own abortion, regardless of method, is known as “self-managed abortion,” but many means of ending a pregnancy are dangerous.) Over the last decade, as a relentless legislative and legal campaign by abortion foes closed clinics and made getting an abortion deeply onerous, abortion rights supporters built a network of resources for people look to end their own pregnancies using pills.
Plan C is one of those resources. Beyond offering an online guide with state-by-state information about how to obtain abortion pills—both with the help of medical professionals and without—the group also orders pills from online pharmacies in order to ensure that they’re not scams.
“Even in states that unjustly restrict access to abortion care, we know that alternate routes of access to medically safe abortion pills are still available,” said Amy Merrill, co-founder of Plan C.
Pills may take up to a few weeks to arrive, Merrill said, and the exact timing can fluctuate. Rarely, though, does she hear about pills getting stopped by customs.
“Obviously, many times during the pandemic, mail was disrupted and flights were disrupted from overseas and from India—where we know one of the manufacturers is based—and so that affected ship times,” she said. “If we're talking about the online pharmacies, they're coming from different services and everyone has a different logistics chain.”
President Joe Biden has said that he plans to protect medication abortion. What does that mean?
On Friday, Biden signed an executive order that emphasized his administration’s interest in protecting access to medication abortion. In that order, he directed Secretary of Health and Human Services Xavier Becerra to, within the next 30 days, prepare a report on how to “protect and expand access to abortion care, including medication abortion.”
However, it’s important to note that, in places where abortion is banned, medication abortion is not exempt—it, too, is banned. Biden cannot miraculously make medication abortion legal in states that pass blanket abortion bans.
We already saw a version of this limitation play out under Biden’s administration. In a “telemedicine abortion,” a patient may talk to a medical professional, who then mails the patient abortion pills. The patient then takes the pills on their own. Last year, Biden’s Food and Drug Administration expanded access to telemedicine abortion, letting people get abortion-inducing pills through the pill. However, by that time, 19 states already had bans on telemedicine abortion.
If I get an abortion at home, am I self-managing my abortion?
The pandemic has rewritten the rules around remote health care, and abortion is no different. Over the last few years, telemedicine abortion has surged in popularity and accessibility, as website like Hey Jane and Just the Pill have sprung up to help people end their pregnancies at a distance. However, thanks to bans on telemedicine abortion that predated Roe’s fall, telemedicine abortion providers have long been legally blocked from offering care in certain states. (Plan C’s online guide has some thoughts on that.)
The difference between a “self-managed abortion” and a “telemedicine abortion” are a bit porous, and people can disagree on the distinctions. But one question to ask is, “Does this abortion interact with the U.S. health care system at all?” If the answer is no, then it’s likely a self-managed abortion, rather than a telemedicine abortion.
This may seem like an academic debate. But as confusion about the legal status of abortion mounts, questions about who’s doing the abortion, and how, are only going to become more important.
Wait, is it now a crime to self-manage your own abortion?
Generally speaking, no. And that was true even before Roe fell, according to Farah Diaz-Tello, legal director for If/When/How, which runs a helpline for people with questions about the legality of self-managed abortion.
“It is no more legal or illegal than it was prior to the Dobbs decision,” said Diaz-Tello, referring to Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe. “But at the same time, we know that just the mere existence of this additional scrutiny on abortion care and the suspicion that it cast it all under makes it more likely that a person is going to experience criminalization, even in the absence of a law that authorizes it.”
Just three states—Oklahoma, South Carolina, and Nevada—explicitly have laws against self-managed abortion on the books. But, Diaz-Tello warns, if a prosecutor is interested in pursuing charges against people over self-managed abortion, they’ll find a way to do it. She pointed to the case of a woman in Texas, who, in April, was arrested for what officials called “a self-induced abortion.” Although she was swiftly released, after the local attorney declared there was no legal basis for a prosecution, her name was still splashed all over the news.
Since 2000, more than 60 people have been criminalized for ending their own pregnancies or helping someone else do so, according to If/When/How, which also runs a legal defense fund for people facing criminal consequences after a self-managed abortion. (The organization will help someone regardless of whether they use pills to induce an abortion.) After the decision on Roe came down, Diaz-Tello said traffic to If/When/How’s website shot up by 1,000 percent.
Right now, abortion restrictions tend to punish people who help provide or obtain abortions, not those who undergo them, and abortion opponents say they want to stick with that strategy. But although Diaz-Tello said it’s important to know who, exactly, an abortion restriction targets, “the law certainly sweeps beyond its target in this realm very frequently.”
“The person who has ended the pregnancy is the person who is most visible and most accessible to the system,” Diaz-Tello said. “If they have a complication, they’re the one who has to go in and talk to health care providers. They’re the one who's going to have the bedside interrogation. They’re the one who’s going to have their mug shot in the news first.”
Merrill knows that even Plan C could face legal consequences, just for providing information about abortion pills.
“We keep coming back to our First Amendment right to share information,” Merrill said. “We think that the moment that we are being censored and shut down from sharing information on a medically safe option in a certain state, then that is the moment we live in a very different United States. That said, we know, again, the intensity of the politics that this country is embroiled within right now.”
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