Will at-home abortions make Roe v. Wade obsolete?

As the Biden government ponders federal regulations on where, when, and from whom patients can get the pills, and a deadline for federal courts in early April, Conservatives are already putting up barriers. In court, in Congress, and in state houses across the country, they’re working to preventively ban the pills or make it harder to get – with bills pending in Indiana, Montana, Arizona, Arkansas, Alabama, Iowa now this year alone.

“They are trying as hard as they can to restrict access to the pills now because they know they will not be able to solve the bell later,” said Mary Ziegler, a professor at Florida State University College of Law Abortion. “It’s just as important as what happens to Roe.”

Biden’s pledge to “follow science” on public health is currently under scrutiny as medical experts, citing new data obtained during the pandemic, argue that remotely administering the abortion drugs is safe and effective .

If federal regulations were to be rewritten, someone in Arkansas, for example, could video-consult a doctor in Massachusetts or even the UK and receive the pills in the mail. Even if red countries were to ban their imports, enforcement would be almost impossible.

“It takes the struggle out of the clinic and into the homes of individuals,” said Alina Salganicoff, director of women’s health policy at the Kaiser Family Foundation. “That will be much more difficult to regulate and could potentially expand access.”

However, women’s health and advocacy groups emphasize that the pills are not a panacea. For one thing, they can only be used safely in the first 10 weeks of pregnancy – a narrow window of time in which many people do not yet know they are pregnant. In addition, taking the pills in a prohibited state can be legally dangerous and discourage people from seeking medical help if they have complications. This fear is not theoretical – already with roe Women who are still there are prosecuted for self-inflicted abortions.

Biden could soon be forced to make a decision. ON The federal appeals court hears a challenge to the Trump administration’s decision to maintain the FDA’s personal dispensing request for the pills during the pandemic, and Biden’s DOJ is due to announce until April 7th whether there are plans to continue enforcing these rules or not.

Even if the Biden administration chooses to defend the Trump rule, there is a burgeoning underground online pill market that, like its counterparts in the formal health system, has seen growing popularity during the pandemic.

Anti-abortionists are already sounding the alarm about this potential wild west.

For years, Republicans in Congress have raised concerns about the safety of the pills and sent letters urging the FDA to take action against the drug and the online sellers who offer it. The latest letters came out as nearly a hundred Republicans last year each Chamber of Congress urged the agency to completely withdraw the drug from the market.

Now that the government is considering lifting federal restrictions on the pill, Conservatives fear that the state bans they are putting in place will not be enough.

“Chemical abortion really sets in Roe against calf about steroids, ”said Kristi Hamrick of the anti-abortion group Students for Life of America. “roe Abortion was possible anywhere in the country during all nine months of pregnancy, but this really is a new frontier – virtual and chemical. “

But for advocates like Silvia Henriquez, co-president of abortion rights group All * Above all, looser federal rules on the pills are part of a long-held goal.

“We are working towards a future where abortion care is where we need it, where it is affordable, accessible, and on our own terms without barriers,” she said. “Drug abortion brings us closer to this world – where it doesn’t matter who we are, how much we earn or where we live.”

As Conservative states have acted aggressively in recent years to restrict access to surgical abortion and passed hundreds of laws that have limited when, where, and how people can use the procedure, there is a demand for cheaper and more convenient abortion pills increased – including online, where patients have received the drug from underground marketplaces as well as from approved providers. In 2001, the drugs were used in only 5 percent of abortions in the United States. According to the Guttmacher Institute, it was 39 percent by 2017. The increase even came as the total number of abortions significantly decreased.

Scientists and doctors increasingly support drug discontinuation and have long called for the abolition of the rules that require patients to pick them up in person, even if they don’t swallow them until they get home. They say it’s a particularly pressing problem during the pandemic, when the government has tried to limit personal dispensing – and funding for telemedicine – for almost every other drug.

Jen Villavicencio, an abortion service provider and health policy officer at the American College of Obstetricians and Gynecologists, told POLITICO that she walked from car to car in her clinic’s parking lot to see patients and dispense the pills after the Supreme Court intervened in January had to restore the patients Trump administrative rules that had been blocked by the lower courts for several months.

“We tried to avoid interactions with other people in order to suppress the increasing number of Covid-19 cases,” she said. “Many drugs with a much higher risk profile were allowed to eliminate personal needs due to the pandemic. However, this courtesy and safety measure was not offered to anyone seeking abortion care or miscarriage management. “

Abortion medication relies on two pills – misoprostol, which is lightly regulated, and mifepristone, which has been more strictly regulated by the FDA since it was first launched decades ago.

Yet Mifepristone “has very few risks at all,” argues Villavicencio. “It’s safer than over-the-counter drugs like ibuprofen and Tylenol. We know this drug can be safely administered via telemedicine because we studied it. “

ACOG, along with the American Medical Association and other leading medical groups, has lobbied the Biden administration and argued in court that federal regulations on the dispensing of the pills should be relaxed. Their push was repeated on Capitol Hill, where Democratic lawmakers have asked Biden to allow telemedicine abortions both during the pandemic and beyond.

However, the decision still poses a political dilemma for Biden, who until recently was relatively conservative about aborting a Democratic politician.

The president has not yet taken a position on the pills. When Biden of the New York Times in 2019 urged whether the drugs should be over-the-counter as part of a Democratic primary questionnaire, he gave a non-binding response, unlike some of his then-competitors like Senator Elizabeth Warren, who urged easier access to the pills.

When asked where it stands on the dispensing requirements for the drugs, the Ministry of Health and Human Services declined to comment and referred to the ongoing litigation. But Xavier Becerra, the California attorney general pending confirmation of the leadership of HHS, last year led a coalition of 21 Democratic AGs that petitioned the FDA to allow telemedicine abortions at least for the duration of the pandemic.

“Forcing women to need unnecessary personal reproductive health care during this public health crisis is stupid and irresponsible,” he wrote at the time.

As they await a decision, opponents of abortion rights are fighting on two fronts: urging Congress, lawmakers, and the FDA to place restrictions on the pills or to ban them entirely, while trying to convince the public that the Pills are dangerous.

For the past three years, groups including Students for Life of America bought ads Online and on TV, created mini-documentaries, sponsored college campus events, and trained members to testify before their state lawmakers about possible complications and side effects of the pills and the risk that women could be pressured or tricked into using them without consent to take.

With easier telemedical access to the pills, conservatives are even warning of the fall of Roe against calf would not restrict their use in states that prohibit abortion.

“There has always been a problem with people crossing state lines to do things that may be illegal,” said Roger Severino, a former top official at Trump’s HHS who now works for a think tank. “It all depends on how the Biden government reacts: if it fulfills its responsibilities, it will restrict the black market for it.”

Conservative fears about mifepristone are nothing new. When the drug was first Introduced in the 1990s, politicians like George W. Bush feared the drugs would popularize the practice.

Evidence since then – and especially during the pandemic – has confirmed those fears. The popularity of so-called teleabortions has increased in the US for years – long before the pandemic – both through the established health system and through more informal underground groups. For example, a January 2020 study in the American Journal of Public Health found increasing demand for a domestic telabortion service that operates underground in states where state restrictions on personal abortion clinics have increased. The federal government has also seized more pills sent from abroad, according to a POLITICO analysis of data on the FDA’s seizure of misoprostol and mifepristone obtained through the Freedom of Information Act.

In 2008, the FDA intercepted nine shipments of abortion drugs, according to FDA data received from POLITICO. In 2018, just a decade later, the number was 26. The agency’s annual totals varied greatly from year to year: a low of 5 in 2015, followed by an increase during the Trump administration of 19 in 2017 and 26 in the year 2018. The number went back to 10 in 2019, the last year for which information is available.

The changing landscape overseas for access to mifepristone is a potential indicator of how widespread the teleabortion practice could be in the US, whether it is legally regrouping under the Biden administration or being kept underground.

In the UK, the nonprofit group MSI Reproductive Choices performed around 16,750 abortions through telemedicine alone in 2020 after the government eased restrictions on the practice. (The country typically has around 200,000 abortions a year.) A new study of the pandemic year in the British Journal of Obstetrics and Gynecology says the practice has been successful: patients wait an average of 4 days less to get an abortion, with little Difference from personal abortions in terms of safety or effectiveness.

Jonathan Lord, the group’s chief medical officer, says the increased ease of procuring medicines has led to broader access to abortion across the board. When women had to go in person to pick up the pills, many vulnerable women – like those who were molested at home – were too anxious to make the trip and feared that their partners would find out what they were doing.

Now the health system can coordinate with the social workers and the police on behalf of the members of the group. “They are also the group that we really, really, really want to be involved with,” said Lord. “Telemedicine really helped here.”

The change has also reduced the importance of some underground groups.

Women on Web, the best-known international group selling abortion pills by mail outside of formal health channels, received contacts from 0 patients in the UK – 35 or 40 per month – in the first few months of the pandemic. In a study of eight European countries, the group generally found increasing demand for their services during the pandemic year – unless the country allowed more teleabortions.

Regardless of what decision Biden and other policy makers make in the coming months, these trends are likely to continue long after the Covid-19 threat ends. The drug is likely the future of the abortion wars, if only because it is the future of abortion.

“There are so many direct and indirect ways that states are restricting access to surgical abortion – from waiting times to notifying parents to requiring special licenses – and I assume they are equally creative with drug abandonment,” said Salganicoff. “Whether they can prevent every pill from getting over the limit is a different story.”

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