As abortion is very likely to soon be illegal in several American states if the judgment Roe v. wade is invalidated, the abortion pill, which can be obtained by post and taken at home, appears to be a possible and unexpected solution for many women. But that’s not counting on the country’s most conservative elected officials, who have already restricted its accessibility – and who continue to build plans for additional barriers.
“The abortion pill does not give a free pass to circumvent an abortion ban”, declares Amanda Allen at the outset. No miracle solution, she says: “It will be a lot more nuanced than that. »
The senior attorney and director of The Lawyering Project, an American organization whose mission is to eliminate laws that limit women’s choices and access to abortion, specifies that “where there is a complete ban, this will also cover abortions by medication”.
The anti-abortion group Americans United for Life recently declared that passing laws against the pill is its “priority” for 2022.
Amanda Allen therefore expects legal attacks on all fronts against the abortion pill – which risks being their new target.
The abortion pill was approved in the United States by the Food and Drug Administration (FDA) over 20 years ago. It then becomes one more option for women who want to terminate their pregnancy, and is recommended by the American College of Obstetricians and Gynecologists, who consider it “safe and effective”.
In 2019, more than half of abortions obtained before 10 weeks of gestation were done this way — and not by surgical termination of pregnancy, according to the Centers for Disease Control and Prevention (CDC), a US government public health agency. .
Possible during the first 10 weeks of pregnancy, medication is taken at home by eligible women, after an initial appointment which can take place via telemedicine.
The abortion pill is different from the morning after pill, which must be taken in the days following sexual intercourse: the latter is used to prevent pregnancy, not to end it.
A prescription is normally required, but some women obtain one without, through online pharmacies, says Plan C.
Legislative obstacles
Since the abortion pill has existed, elected conservatives across the country have been trying to erect legislative barriers limiting its accessibility.
Some have banned initial telemedicine appointments and mail-outs (such as Texas and Oklahoma), or have restricted them.
These restrictions, such as the requirement of the physical presence of the doctor during ingestion, are often presented as beacons established to protect women’s health. But that’s just window dressing, according to Elisabeth Smith, policy director at the Center for Reproductive Rights.
“Time and time again, science has proven that medical abortion is a safe and effective method of terminating a pregnancy,” she says by email. Limits on taking one pill of mifepristone and another of misoprostol “are not medically necessary and are based on misinformation. This proves that restrictions on abortion have nothing to do with people’s health”.
The greatest risk for women is not medical, but rather that of criminal prosecution, also argues Maggie Olivia of Pro Choice Missouri.
As restrictions pile up in their state, women are trying to get the abortion pill in those where it is permitted, as they do for in-office abortions. They also come up against obstacles.
One is that some states have legislated that doctors can only prescribe the pill within their physical borders.
In short, a woman in Mississippi cannot have a telemedicine appointment from home with a doctor in Illinois and then have the pill mailed to her. She has to physically travel to Illinois to attend her appointment — even from her car, with her cell phone — and then pick up the pill in person. It is the place where the patient is at the time of receiving the service that governs this situation, underlines Mr.me Allen.
Other attempts at restrictions are in the cards of elected Conservatives.
A bill has been introduced in Missouri to punish out-of-state pharmacists who help women obtain abortions with the abortion pill. Another piece of legislation being considered in that state would make it illegal for a person to assist another to leave the state to obtain such an abortion or to carry the abortion pill for others.
“It will create a legal headache and a mess,” says Mme Allen.
“You see states trying to infiltrate the borders of other states to regulate the conduct of certain people there. This raises very complex legal questions, and many have never been tested in court, she continues. Abortion advocacy groups are looking for ways to challenge these laws, including invoking the constitutionally protected right of citizens to travel freely between states.
We can therefore expect another wave of challenges in the courts, she believes.
” Cancel Roe v. wade will lead to total chaos, says the lawyer. States will gang up on each other, attempting to enforce their own laws on residents of other states. »
International orders
Another option is to order the abortion pill from outside the United States.
One option among many is Aid Access, an international service launched in 2018 in the United States by Dutch doctor Rebecca Gomperts.
Several aspects of this situation remain in a gray area, according to experts. Pro-abortion groups fear that in a future without Roe v. wadestates directly criminalize the woman who takes the combination of drugs received in the mail.
Indeed, some states have already arrested and charged women for terminating their pregnancies themselves, whether through mailing or other methods. The Guttmacher Institute, a research center dedicated to advancing reproductive rights, has documented about a dozen cases, though it believes the total is higher.
Although it may be difficult for the authorities to find out that a woman has taken the abortion pill, it is not excluded that she will be denounced by a third party.
States are also considering how to ban the delivery of pills by mail. But the postal service falls under the federal government, recalls Mme Allen, who sees it as “a conflict of legislative powers”.
And then, the abortion pill is not the solution in all cases: first, its bill makes it out of reach for the poorest women (its median cost is US$560, according to a study by Health Affairs), and then it can usually only be taken before the tenth week of pregnancy.
Despite the obstacles, the pill will still make life easier for women seeking an abortion, adds Ms.me Allen.
“Abortion bans do not prevent abortions. They prevent them only for those who do not have financial means. »
This report was funded with support from the Transat-Le Devoir International Journalism Fund.