With the fate of Roe v. Wade hanging in the balance after last week’s Supreme Court hearing and the Supreme Court’s latest decision to allow Texas’ repressive Senate Bill 8 to remain in effect despite allowing abortion providers to sue state officials to block the ban, reproductive rights activists are advocating for advanced provisions and abortion-by-mail options to sidestep repressive state laws on surgical abortions. While the FDA has approved use of the abortion pill for up to 10 weeks and has lifted in-person dispensing requirements for the duration of the pandemic with a pending long-term reevaluation that could be announced as soon as next week, states like Texas are still imposing contradictory laws. Last week, on the heels of the Supreme Court’s oral arguments, Texas’ Senate Bill 4 went into effect, which criminalizes medication abortions after seven weeks and requires in-person dispensing, prohibiting pills to be mailed to patients. Activists are saying this development could cause trigger bills across other red states placing limitations on medication abortions, adding more constraints on abortion care, and putting pregnant people at risk.
“It’s never been more clear that anti-abortion laws are designed to stop access to abortion care and have never been about safety,” says Ana Rodriguez, campaigns director for Lilith Fund, a reproductive equity organization based in Austin, Texas. “These laws always impact Black, Indigenous, and other people of color the most. It’s a really scary time for people who need access to abortion care, as well as the network of support that wants to help people access abortion care.”
Medication abortion, which is a protocol that involves taking two different drugs, mifepristone and misoprostol, has been a safe alternative to surgical abortions in the U.S. since 2000, and in 2017 it accounted for 39% of all abortions in the country. According to a 2016 Advancing New Standards in Reproductive Health (ANSIRH) study, mifepristone, otherwise known as “the abortion pill,” is medically safer than Tylenol and Viagara. But 32 states have imposed limitations that contradict World Health Organization recommendations ensuring that midlevel providers can safely provide medication abortion, two states have completely banned the use of it at a specific starting point, and 19 states require the prescribing physician to be physically present when the medication is administered, ruling out telehealth and mail options. Under SB 4, medical providers who prescribe mifepristone after seven weeks, via telehealth, or dispense them through the mail will face state jail time and a fine up to $10,000.
“We’ve had 21 years of experience with this medication and it’s been shown to be very safe and effective,” says Dr. Daniel Grossman, director of ANSIRH. “There is no medical reason for mifepristone to have to be administered in person.”
For pregnant people who find themselves in states with strict abortion laws, or rural towns with few if any abortion care providers, and cannot afford traveling to another state for care, receiving the abortion pill by mail has been a vital resource. Despite state restrictions, initiatives like Shout Your Abortion and Aid Access are raising awareness about the abortion pill and helping people aquire the medication who cannot access local abortion services.
“Abortion pills by mail is the best way that we have to mitigate the impacts of whatever anti-choice legislation we see past incoming years,” says Amelia Bonow, founding director of Shout Your Abortion. “Even if abortion is banned in their state, we hope that people know they can still have a safe, effective abortion early in pregnancy and they can also have a lot of support in that process.”
Many activists are still unsure how SB 4 will enforce “abortion-by-mail” bans, since it would imply a breach of privacy to inspect people’s mail, which is a federal offense.
“[SB 4] is really just meant to instill fear in people who are trying to do this work,” says Nancy Cárdenas Peña, Texas director of policy and advocacy for the National Latina Institute for Reproductive Justice.
Grossman is a firm advocate for advanced provision, when medication is provided before it is immediately needed, in a “wrap-around service” that would allow a clinician to provide educational information about the pills and how to recognize potential complications or recognize if they are not working. He also suggests that clinicians make themselves available to patients through the phone in case they have any questions about taking the medication. Medical and legal hotlines are available at the Repro Legal Helpline and the Miscarriage and Abortion Hotline, which is a hotline staffed by pro-choice medical professionals who will anonymously answer any questions and provide medical advice and support to self-manage an abortion.