The next fight for access to abortion will focus on pills

SIOUX FALLS, SD (AP) — It took a 32-year-old South Dakota woman two trips across state lines, on icy roads and through a patchwork of state laws to get abortion pills last year.

For abortion seekers like her, such travel, along with pills mailed through the mail, will gain in importance when the Supreme Court carries out its leaked draft opinion that backed the landmark Roe v. Wade and would allow individual states to ban this procedure. The woman, who spoke on condition of anonymity because she was concerned for her family’s safety, said the abortion pills allowed her to end an unexpected and high-risk pregnancy and remain devoted to her two children.

But anti-abortion activists and politicians say their next move will be to stop that cross-border travel, doctor’s consultations and pill shipments.

“Medical abortion is a decision about access to abortion,” said Mary Ziegler, a professor at Florida State University College of Law who specializes in reproductive rights. “That will be the battlefield that will determine how enforceable abortion bans are.”

The use of abortion pills has increased in the US since 2000, when the Food and Drug Administration approved mifepristone — the main drug used in medical abortions. More than half of abortions in the United States are now performed with pills rather than surgery, according to the Guttmacher Institute, a research group that advocates for abortion rights.

The FDA last year lifted a long-standing requirement that women pick up abortion pills in person. Postal delivery is now also permitted nationwide.

These moves have spurred online services that offer information on how to get abortion pills and counseling to get a prescription. After the woman in South Dakota found that the state’s only abortion clinic could not schedule her in time for a medical abortion, she found an online service called Just The Pill, which advised her to travel to Minnesota for a phone consultation with a doctor . A week later she came back to Minnesota for the pills.

She took the first one in her car almost immediately and then cried as she drove home.

“I felt like I lost a pregnancy,” she said. “I love my husband and I love my kids and I knew exactly what I had to say goodbye to and that was a really awful thing.”

South Dakota is among several states, including Texas, Kentucky, Arkansas, Ohio, Tennessee and Oklahoma, where Republicans have restricted access to abortion pills in recent months. South Dakota Gov. Kristi Noem said additional in-person visits for the pills and a ban on sending them through the mail are needed to protect women and save “unborn children.” A total of 19 states require a medical clinician to be physically present when abortion pills are administered to a patient.

In addition to crossing state lines, women can also turn to internationally-based online pharmacies, said Greer Donley, a professor of reproductive health at the University of Pittsburgh Law School. Some women also have prescribed pills shipped across the states with no restrictions.

“It allows someone to have an abortion without having a direct role as a provider. It’s becoming much harder for states to control access to abortion,” she said, adding, “The question is how to enforce it.”

Sue Leibel, the state political director of Susan B. Anthony List, a prominent anti-abortion organization, acknowledged that it is an issue that has “crept up” among Republican lawmakers.

“This is a new frontier and states are wrestling with enforcement mechanisms,” she said, adding, “The advice I always give — if you close the front door, the pills will come in the back door.”

Anti-abortion activists claim they have no intention of prosecuting women who want an abortion.

Instead, Leibel suggested that the next target for government enforcement should be the pharmacies, organizations, and clinics that offer the abortion pills. She also said abortion-rights opponents should focus on choosing a presidential candidate who would work to reverse the FDA’s decision.

The FDA said a scientific review supports expanding access to the drugs, noting complications are rare. The agency has reported 26 drug-related deaths since 2000, although not all can be directly attributed to the drug due to existing health problems and other factors.

But as new lawsuits loom and abortion seekers make greater efforts to get the procedure, law professor Donley worries state lawmakers may turn their attention to the women receiving the pills.

“Many anti-abortion lawmakers might realize that the only way to enforce these laws is to prosecute the pregnant person themselves,” she said.

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