Increasing demand for mail-order abortion pills after SC ruling

Source: Financial Times

Telehealth abortion providers have reported a surge in inquiries following the US Supreme Court’s ruling overturning Roe vs Wade, as the rapidly proliferating number of states banning terminations forces more women to turn to mail-order pills to end their pregnancies.

Hey Jane, a telehealth provider which operates in six states, said patient demand more than doubled following Friday’s judgment, compared to last month’s daily average. Just The Pill, a non-profit operator offering medication abortion by mail since October 2020, said it received almost 100 appointment requests, about four times the usual number.

Aid Access, a provider founded by Dutch campaigner Rebecca Gomperts, said email inquiries from the US have risen following the landmark ruling, resulting in an immediate ban or strict restrictions on abortion in more than a dozen states. The group said it has received about 4,000 requests a day since Roe was overturned, compared with 600 to 700 a day before that.

Over the past decade, medication abortions — involving consuming two drugs, mifepristone and misoprostol, to terminate a pregnancy within the first 10 weeks — have gone from representing a quarter of all terminations in the US a decade ago to more than half.

Many health experts say it offers a safer, cheaper and less-invasive alternative to surgical procedures. Amid the Covid-19 pandemic, US federal regulators last year authorized telehealth providers to post pills directly to women’s homes with no need to visit a doctor or pharmacist in person.

But telehealth providers, which typically provide online consultations with doctors before posting pills, are fast becoming the next battleground for reproductive rights in the US with Republican-controlled legislatures passing laws aimed at limiting their operations.

“Abortion pills will be crucial in shaping access” now that Roe has been overturned, said Mary Ziegler, professor of law at Florida State University.

“Some of the companies that mail abortion pills will be unwilling to do so in states where abortion is a crime. Non-profits, including Aid Access, which are headquartered overseas beyond US states’ legal jurisdiction, are a different story.”

According to research by the Guttmacher Institute, a pro-abortion rights group, 19 states have laws requiring a clinician prescribing abortion pills to be present when they are ingested, effectively prohibiting their prescription via telemedicine. At least six states, including Texas and Missouri, have already enacted specific laws to ban telehealth abortions.

On Sunday, Kristi Noem, South Dakota’s Republican governor, pledged to ban mail-order pills, saying she felt it put people in a dangerous situation because there was no medical supervision. Doctors, rather than the women themselves, would be liable for prosecution, said Noem, who is an opponent of abortion rights.

However, such bans face legal challenges. GenBioPro, which makes a generic version of the abortion pill, sued Mississippi in 2020 to block restrictions on medication abortion, in a case that will test whether US Food and Drug Administration rules on ensuring access to safe medication supersede state laws. A decision is expected later this year.

The Biden administration has also indicated it will seek to prevent states from banning abortion pills — although it has not yet specified how it plans to protect doctors or abortion providers from prosecutions under state law.

Attorney-general Merrick Garland last Friday released a statement reiterating that regulators at the FDA had approved the use of mifepristone, and that US states “may not ban the medicine based on disagreement with the FDA’s expert judgment about its safety and efficacy”.

Ziegler said it would be difficult for them to enforce the law, particularly against overseas providers, especially if states keep their promise not to punish women. Some experts predict women could ask friends who live where the pills are legal to post them across state lines.

Most telehealth providers such as Hey Jane and Just The Pill do not mail abortion pills directly to women in states that ban the practice, which limits their ability to make up for the loss of other abortion services in there. Aid Access, however, uses European doctors to provide online consultations and a pharmacy based in India and deliver the pills to women in contravention of state laws.

Gomperts at Aid Access said that while the Supreme Court ruling represented a devastating blow to civil rights in the US and would harm many women, it was not a return to the situation before the 1973 Roe decision because of the availability of abortion pills.

“There are abortion pills and there is the internet so it will be easier for people to get access to abortion, particularly in the first trimester. Abortion pills you cannot stop.”