The October and November debates finally saw Democratic presidential candidates answer questions about abortion from moderators, months after reproductive health organizations and pro-choice advocates launched a pressure campaign to get 2020 contenders to talk about the issue on primetime television.
So far, candidates' plans for protecting abortion rights have consisted primarily of pledges to codify Roe v. Wade, which would require pro-choice majorities in the House and Senate to pass federal legislation upholding the principles of Roe in the event that the Supreme Court overturns or guts the 1973 decision.
Not only does such a plan depend on Democrats' ability to win back the Senate, but it ignores the extent to which Roe has failed to guarantee abortion access for millions of Americans, particularly low-income people. Even with Roe on the books, as of 2017, almost 90 percent of counties in the United States had no abortion clinic, and in 27 states, people seeking abortions have to make multiple trips to a provider, due to state-mandated waiting periods of up to 72 hours. A federal ban on insurance coverage of abortions for people with Medicaid is another obstacle.
In order to have a more comprehensive conversation about the state of abortion access in the U.S., we asked the seven candidates who've qualified for the December 19 debate about their stance on something very specific: medication abortion.
Reproductive health experts have said that one of the most effective ways to expand access to abortion would be to lift the longstanding restrictions on mifepristone, one of two drugs doctors prescribe for medication abortion, or abortion done with pills early in pregnancy. As they stand, the restrictions—put in place by the Food and Drug Administration in 2000—make it illegal to sell the drug online or dispense it in pharmacies. Doctors must receive specialized training to prescribe the drug, which means not all do, and can only administer it in person, in a clinic or hospital setting. (The second drug, misoprostol, is not under the same restrictions, but both are required for the procedure.)
Currently, almost 40 percent of abortions are done with pills, a record high. But experts say that percentage could be much higher were it not for the decades-old FDA regulations, which have been opposed by organizations like the World Health Organization and the American College of Obstetricians and Gynecologists. Lifting the restrictions would also mean more people would have access to early abortion, since medication abortions occur before the 10-week mark.
“This is a method patients are becoming more comfortable with,” Elizabeth Nash, the senior states issues manager at Guttmacher Institute, told VICE in September. “If the FDA lifted the restrictions on mifepristone, then it would be much more accessible. That would be a game changer for many patients.”
There are a few ways presidential candidates could address this crisis of access. A president could appoint an FDA commissioner who is open to revisiting the regulations on mifepristone. They could also take executive action on telemedicine: At the moment, 18 states have bans on providers prescribing medication abortion via telemedicine consults. Even if the FDA rolled back its mifepristone restrictions, telemedicine bans would keep medication abortion out of reach for many of the patients in those states, given the long distances they often have to travel to get in-person treatment.
Of the four qualifying candidates who responded, South Bend, Indiana, Mayor Pete Buttigieg said that while he supports the “spirit of the policy suggestion” he believes that, when it comes to offering the meds over the counter, we “need more research into the pros and cons and unintended consequences of its use in the context of the United States.” This, of course, is despite research that shows medication abortion is safe and effective, even when it’s self-administered. Massachusetts Senator Elizabeth Warren and Tom Steyer both said they support making the medication available over the counter, while Andrew Yang only went so far as to say he supports expanding access to telemedicine.
Former Vice President Joe Biden, Minnesota Senator Amy Klobuchar, and Vermont Senator Bernie Sanders did not return VICE's requests for comment, but have made their general positions on abortion clear in other contexts.
Former Vice President Joe Biden did not respond to VICE's request for comment.
When the New York Times sent 2020 candidates a wide-ranging survey about their views on abortion, the Biden campaign didn't provide an answer to the question, "[Would you] make misoprostol and mifepristone available over the counter?" In an accompanying statement, a spokesman for his campaign reiterated that Biden would protect abortion rights through measures including codifying Roe v. Wade, repealing the Hyde Amendment, and funding Planned Parenthood.
"Medication abortion is known to be safe and effective and could expand abortion access, especially for those who live in remote areas, or in states where routine, private and non-judgemental abortion care is limited. While I support the spirit of this policy suggestion and efforts to expand the availability and accessibility of abortion for all, there are a few major barriers we must overcome before misoprostol and mifepristone can be sold over-the-counter (OTC).
“First, a self-administered abortion is illegal in some states, so making it available over-the-counter could have the unintended consequence of setting people up for a criminal investigation or even jail. We must first work on decriminalization efforts. Second, there are currently several regulatory constraints limiting mifepristone’s distribution and prescription. To overcome these, we will have to work closely with regulatory bodies such as the FDA to lift these restrictions.
“The OTC approach holds great promise, but we also need more research into the pros and cons and unintended consequences of its use in the context of the United States. Steps we can take in the interim to improve access to abortion include expanding access to abortion via telehealth, eliminating the Risk Evaluation and Mitigation Strategy (REMS) warning that ignores decades of evidence indicating that these medications are safe, and expanding the types of medical professional able to prescribe them."
Minnesota Senator Amy Klobuchar did not respond to VICE's request for comment.
In response to the same New York Times abortion survey, Klobuchar responded that she was "unsure" if she would make misoprostol and mifepristone available over the counter. Klobuchar has no other on-the-record statements about medication abortion. A spokesperson told the Times Klobuchar would repeal the Trump administration's Title X policy—which bans doctors from referring patients for abortions in federally-funded family planning clinics—during her first 100 days in office. Klobuchar also supports codifying Roe.
Vermont Senator Bernie Sanders' campaign did not respond to VICE's request for comment.
Sanders' campaign told the Times that "Regarding the availability of new over-the-counter medication: Bernie is open to discussing ways to lower barriers of access for women to receive comprehensive reproductive care." His Medicare for All plan would provide free abortion care, which would significantly expand access to the procedure for low-income Americans.
Denise Lopez, the press secretary for the Steyer campaign, told VICE: "Healthcare is a right and we should be uncompromising when it comes to protecting the rights and dignities for women. Reproductive rights are human rights. Every woman has a right to make her own health care decisions, and every woman should have the ability to access abortion services. That’s why Tom supports making medication abortion available over-the-counter, and as president he would fight tirelessly to expand access to Medicaid and women’s health services. By upholding discriminatory restrictions on medication abortion, President Donald Trump and Republicans in Congress have robbed women––particularly low-income women and women of color––of their right to bodily autonomy.
For decades, anti-choice advocates have been undermining that right. States are enacting absurd obstacles to access reproductive health care, such as outright bans, closing down clinics, demanding waiting periods for examinations, and restricting abortion coverage in insurance plans.
We need to make sure that everyone who needs access to reproductive health care receives it, regardless of their income level or where they live. It is time that we repeal the Helms and Hyde Amendments, fully fund Planned Parenthood and codify Roe v. Wade into law."
"Restrictions on medication abortion are medically unnecessary and exist for only one purpose: to functionally eliminate the ability of women to access abortion services. As President, I will direct the FDA to lift restrictions on misoprostol and mifepristone so that they can be made available over the counter."
S.Y. Lee, the Yang campaign’s national press secretary, told VICE: "Andrew Yang supports the right of women to choose what they can and cannot do with respect to their own bodies. He believes any healthcare plan should cover comprehensive sexual and reproductive health services, including abortion services. He has long advocated for changes to licensing standards to increase access to telemedicine."
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