Abortion care has changed dramatically in the last two decades with the advent of “medication abortion.” The so-called abortion pill allows women to seek care privately and manage the process at home, which has the side benefit of helping them avoid anti-abortion protesters outside clinics.
Today, medication abortion, which is considered safe and effective for up to 10 weeks of pregnancy, accounts for the majority of abortions in the U.S., according to the Guttmacher Institute, a reproductive rights organization. But access to the medication is now in question throughout the states that are expected to swiftly ban abortion following the Supreme Court’sof the landmark 1973 Roe v. Wade decision.
The Supreme Court ruling last week effectively splits the availability of abortion care across the nation. The procedure isin about half of U.S. states and protected in the other half. Shortly after the decision on Friday, abortion clinics in states such as Alabama, Texas and West Virginia for fear of prosecution.
But medication abortion poses additional questions and grey areas, given that the medication can be prescribed via a telehealth visit and mailed to a woman’s home. Considering those differences, it’s likely that many women will be able to continue to access medication abortion in states with abortion bans, although they may face risks, experts say.
“There are a number options that range from low risk to high risk — like ordering them online, having a friend mail them to you,” said Amanda Allen, senior counsel and director of the Lawyering Project, which provides legal assistance to abortion providers and researchers. “You could have a medical appointment on the border [of a state where abortion is legal] and have it shipped to a P.O. Box.”
States that are outlawing abortion make no distinction between medication abortion and surgical abortion, Allen added. Because of that, pursuing medication abortion within those states will carry risks, both for the woman seeking care as well as the medical professionals who aid her, she said.
But there will likely be ways around those roadblocks, such as traveling out of state or ordering the pills from overseas providers, Allen said.
Here’s what to know about medication abortion after the overturn of Roe v. Wade.
What is medication abortion?
Also called the abortion pill, medication abortion is a combination of two drugs: mifepristone, which was approved by the U.S. Food and Drug Administration in 2000, and misoprostol.
The first drug stops the pregnancy from growing, while the second drug causes the uterus to empty, a process that typically takes between four to five hours and is similar to a miscarriage, according to Planned Parenthood.
Why has it become widely used?
The process is “more private” than going to an abortion clinic, noted Elizabeth Nash, principal policy associate, state issues, at the Guttmacher Institute. “It feels much more like you are in control, and you don’t have to deal with protesters,” she added.
Thirty-two states require physicians to prescribe the medications, while the remaining states allow advanced practice clinicians such as nurses and physician assistants to provide the pills.
Another recent change has also helped make the medication more accessible. In December 2021, the FDA allowed medical professionals to prescribe the abortion oill via telemedicine visits. Currently, 31 states allow this.
However, restrictions on telemedicine prescriptions remain, given that 19 states — mostly in the South and Midwest — ban medical professionals from prescribing the abortion pill via telehealth visits, according to the Kaiser Family Foundation.
How much does it cost?
The typical cost of a medication abortion is about $550, according to researchers at University of California San Francisco. That typically includes the cost of the medication as well as the consultation with a medical professional.
It’s also similar in cost to a first-trimester surgical abortion, the researchers found.
Can women in states with abortion bans get the pills from states where it’s legal?
Not likely. Take a woman in Missouri, where abortion is now illegal except in cases where a woman’s life is in danger. She could book a telehealth visit with a medical practitioner in a state where abortion remains legal, such as California, but the California doctor could face legal risks if she prescribes the abortion pill to the patient, Allen of the Lawyering Project noted.
“Mailing those medications would be breaking state laws, and that provider could be subject to penalties and license suspension,” Allen said. “These are huge risks — and people work their entire lives to earn their medical degrees.”
Because of those risks, experts believe it’s unlikely that medical professionals in states where abortion is legal would prescribe and mail the pills to states where it is now banned.
Can women travel to get access to abortion pills?
Yes, because people have the right to interstate travel. Women can travel to states where abortion is legal to get either medication abortion prescriptions or pursue surgical abortion, experts noted.
However, some experts believe that conservative states may seek to halt the ability of pregnant women to get abortion care out of state.
Yet traveling can add hundreds of dollars to the cost of seeking an abortion, which typically costs about. That may mean traveling is an out-of-reach option for many low-income women, as well as for women who have children and can’t easily travel, as well as those who can’t take time off from work to make a trip.
One provider is trying to move closer to women in states that are banning abortion. Just the Pill, a provider of abortion pills in Minnesota, Montana and Wyoming, started a mobile clinic program that operates on state borders.
“Our mobile clinics can quickly adapt to the courts, state legislatures and the markets, going wherever the need is greatest,” Just the Pill said on Friday.
What about ordering abortion pills from overseas?
That may be one of the lowest-risk and easiest options, experts say.
Providers like Aid Access, a European telemedicine service that prescribes abortion pills to women in the U.S., has already seen an “enormous increase” in Americans looking to obtain the medications. The surge came in the wake of the leaked draft opinion that this month overturned Roe v. Wade.
“So I would say, buckle up, women in the U.S. Just get your abortion pills in your medicine cabinet, so you have it in case you need it,” Dr. Rebecca Gomperts, who runs Aid Access,CBS News last month.
The process with Aid Access works via an online consultation, with the service then connecting the patient with a U.S.-based health care provider who can prescribe the pills. If they face restrictions within their home state, women may be connected with Gomperts herself, who can issue a prescription online and recommend an online pharmacy outside the U.S. to fill it. The medication requires about 10 to 20 days to arrive.
“We expect to see more people ordering from Aid Access,” noted Allen.
But, she added, there is still some risk in doing this. “If a law enforcement official had reason to believe someone was doing an illegal abortion, they could go after someone ordering the pills,” she said.
Even though most states don’t prosecute a person seeking the abortion — typically, it is the medical provider who faces the legal risk — women have been charged for abortions that are illegal in their states. For instance, Lizelle Herrera was arrested in Texas for a self-induced abortion,” although the charge
In 2017, a Mississippi womanwas indicted for second-degree murder after she suffered a still birth 36 weeks into her pregnancy; the charge was later dismissed.
Is there a legal challenge to state restrictions on abortion pills?
There’s a pending case in Mississippi that is challenging the state’s right to restrict mifepristone.
Filed by the generic maker of the drug, GenBioPro, the lawsuit contends that the FDA’s regulations for the drug preempts Mississippi’s requirement that a physician prescribe it in person, according to Bloomberg Law. (The FDA allows medical professionals to prescribe via telehealth visits, as mentioned above.)
“It’s an exciting legal theory,” noted Allen of the Lawyering Project.
The case could also form the basis for an argument from the Biden administration, with U.S. Attorney General Merrick Garland on Friday nodding to the FDA’s rules permitting the use of abortion pills.
“In particular, the FDA has approved the use of the medication mifepristone,” Garland said in a statement. “States may not ban mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy.”
—With reporting by CBS News’ Haley Ott