Abortion pills will be center of next legal battles

In the fight over reproductive rights, medication abortion is emerging as the next legal battleground.

Medication abortion — a combination of two drugs that end a pregnancy — is the most common form of abortion in the U.S., rising from 39% of all cases in 2017 to 54% in 2020. Last Friday’s stunning ruling by the Supreme Court, overturning Roe v. Wade on a 5-4 vote and ending a constitutional right to abortion, is expected to trigger even greater interest in the pills.

“It’s very safe and effective, and you can do it in the privacy of your home” if used within 10 weeks, said attorney Laurie Sobel, associate director for Women’s Health Policy at San Francisco’s Kaiser Family Foundation, a nonprofit organization focusing on national health issues.

But Republican-led states are moving to re

strict or even ban access to the drugs, which are approved by the U.S. Food and Drug Administration.

Moments after the Supreme Court ruling, the federal government said it would seek to protect access to medication abortion.

“States may not ban mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy,” said U.S. Attorney General Merrick Garland. President Biden said efforts to restrict it would be “wrong and extreme and out of touch with the majority of Americans.”

There is no guarantee that the Biden administration will prevail. The courts may side with the conservative states, noting that even though the drugs have been proven safe and effective, they still induce abortions illegal under the laws of those states, said Hank Greely, director of Stanford University’s Center for Law and the Biosciences.

“This Supreme Court is not going to uphold such a decision,” said Greely. “The Supreme Court will let states ban it because … it wants to.”

Here are some questions and answers about medication abortion.

Q: How does medication abortion work?

A: It’s a combination of two medications, taken one to two days apart. When used within 10 weeks, the combination is up to 98% effective.

The first is a pill called mifepristone, or Mifiprex, which blocks the hormone that allows a pregnancy to grow. Some people may experience vaginal spotting or bleeding or even light cramping

The second is a tablet called misoprostol, or Cytotec, which causes the cervix to dilate and the uterus to contract, expelling the pregnancy. It causes uterine cramping and on-and-off bleeding for a few days to weeks.

Q: How is it different from a “morning after pill,” such as Plan B?

A: Plan B is emergency contraception that is taken within the first 72 hours after unprotected sex. It contains a hormone that prevents pregnancy by delaying or preventing ovulation.

Q: Is medication abortion legal in California?

A: Yes. Many California health centers offer medication abortion through telehealth, where you talk to your health care provider on the phone or via video chat. The treatments can be completed at home. They usually feel like a heavy, crampy period.

Because abortion care is considered basic health care, most insurance plans must cover it.

A: I’m in California, but I don’t have a doctor. Can I get the medication online?

Q: Yes. California women can access medication abortion through online clinics such as Abortion on Demand, AidAccess, Choix and Hey Jane. After a consultation with a medical provider, medication is delivered within five days. The clinics typically accept any form of ID with name, photo, address and date of birth.

Q: If I live in a state where medical abortion isn’t legal, can I come to California to get the prescription?

A: Presumably. While some states are acting to interfere with the right to travel out of state for reproductive services, most attorneys say that freedom of movement between states is constitutionally protected.

In Friday’s Supreme Court holding, even conservative Justice Brett Kavanaugh wrote: “… May a State bar a resident of that State from traveling to another State to obtain an abortion? In my view, the answer is no, based on the constitutional right to interstate travel.”

Q: I live in a state that bans abortion and can’t travel to California. Can a California doctor and pharmacy provide the medication to me?

A: No. Doctors who are licensed in California must practice in California. They can only provide out-of-state care if they are licensed in that state.

If your state bans access, you would have to travel to California for a telehealth appointment, then wait for a delivery to a California pick-up location. The teleheath software will confirm you are in California during your online appointment.

Q: I don’t live in a state where abortion is legal. Is there a way to get these online pills without traveling?

A: It is technically illegal for Americans to order prescription drugs from overseas. However, the federal government has limited ability to restrict mail-order prescriptions.

Aid Access, founded by Netherlands physician Rebecca Gomperts and incorporated in Austria, sends medication to women in the U.S. regardless of the laws in their state. Because the medication is shipped from India, it may take longer to arrive.

Q: I’m a California resident who wants to help women in states where abortion is illegal. I’m not pregnant. Can I get a prescription?

A: A prescription drug is meant for you, not for someone else. But proof of pregnancy is not required and some doctors provide it to women who are not pregnant under an “advance provision,” so that it is in their medicine cabinet in the event of pregnancy.

Q: Can I drive across state lines and distribute the drugs in a banned state or mail the drugs to someone out of state?

A: At your risk. If you travel from California to Mississippi to deliver a suitcase full of medication, for instance, you’re violating Mississippi law. It’s considered “aiding and abetting” an abortion. If you’re arrested, California law isn’t there to protect you.

As far as mail, It is particularly hard to regulate mail delivery. The U.S. Postal Service will not inspect every package to see if it contains the medication — which, after all, is legal under federal law.

“There’s going to be a ‘gray area’ between what’s legal, what’s enforceable, and what people feel comfortable doing,” said Sobel. “There’s going to be a different risk assessment for different people.”