Americans wishing to end pregnancies increasingly may turn to the abortion pill if the Supreme Court overturns Roe v. Wade, as anticipated by the draft decision that was leaked on Monday.
The prescription drug combo, also called medical or medication abortion, already is common and became more accessible by mail during the pandemic.
It could see surging interest if a Supreme Court ruling curtails abortion rights in many states, said Elisa Wells, cofounder of Plan C, a website that rates abortion pill suppliers worldwide.
“In very restrictive states, access would be totally cut off and clinics would shut down,” Wells told The Inquirer in a 2021 interview. “That would create a huge market for abortion pills through alternative means.”
Although abortion of any kind is controversial, current law in Pennsylvania and New Jersey would allow medical abortions to continue even if Roe were struck down. Here’s what you need to know:
How does the abortion pill work?
Unlike surgical abortions performed at medical clinics, the so-called abortion pill is taken orally and/or vaginally to end a pregnancy.
The process involves two medications, mifepristone, a hormone blocker, and misoprostol, which triggers uterine contractions that cause a woman’s uterus to empty. The mifepristone is taken first, followed by misoprostol a day or two later. If used within eight weeks of the first day of a woman’s last period, the drugs are 94% to 98% effective at terminating pregnancies, according to Planned Parenthood. At 10 to 11 weeks, the effectiveness drops to 87%.
There is no medical need to visit a doctor’s office after taking the pills, and the pregnancy can be ended in the person’s home.
How common is it?
More than half of all terminated pregnancies occur through medication abortions, according to a 2022 report from the Guttmacher Institute, an abortion rights research and advocacy organization. They became more common in the pandemic, as COVID-19 kept people out of doctors’ offices.
Mifepristone has been available in the United States since 2000. At the beginning of the pandemic, the U.S. Food and Drug Administration waived requirements for in-person pickup for virtually all medications, except mifepristone.
The FDA made mifepristone temporarily available through the mail in February 2021, then made that ruling permanent in December.
Organizations such as the American Medical Association and the American College of Obstetricians and Gynecologists said there was no medical reason to restrict mifepristone.
In 2017, the American Civil Liberties Union sued the FDA on behalf of abortion providers and medical groups, arguing that the ban on mailing abortion pills created “significant burdens on low-income patients, people of color, and people living in rural areas,” according to the organization’s website. That suit ended with the change in FDA policy.
How to get the abortion pill in Pennsylvania and New Jersey
Both Pennsylvania and New Jersey allow people to receive abortion pills prescribed by a medical provider through the mail, according to a report by Stateline, an initiative of the Pew Charitable Trusts.
Pennsylvania patients must have a consultation with a certified abortion provider 24 hours before they can be prescribed the medication and provide signed consent, but that can be done virtually, according to KFF, a nonprofit organization focused on health issues.
New Jersey does not restrict obtaining prescriptions for the drugs virtually or ordering them through the mail.
Federal rules require at least an online consultation to get a prescription. Trained prescribers and pharmacies providing the drugs have to be certified. States can be more restrictive, though, and the pills aren’t legal everywhere.
Texas bars the use of abortion pills after seven weeks of pregnancy. Three states — Arizona, Arkansas and Texas — have a ban on mailing abortion pills to patients, according to the Associated Press.
Challenging medication abortions is fraught for opponents of abortion rights because they typically don’t support criminalizing women seeking abortions, the Associated Press reported, and because mailed pills are hard to police even in states that ban them. Americans United for Life, an anti-abortion advocacy group, called curbing their use one of the year’s most “pressing priorities,” the New York Times reported last month.
Legislators in 22 states have proposed more than 100 restrictions to medication abortions since the beginning of the year, the Times reported.
Even with the FDA’s decision, 19 states have already restricted access to abortion pills by requiring a clinician to be present when the medication is taken, the Guttmacher Institute report stated.
As of March, 16 states had introduced legislation that could ban or restrict access, according to Guttmacher. The bills propose banning the use of the drug, prohibiting people from receiving it by mail, or barring people from using telehealth to obtain a prescription. None has been introduced in Pennsylvania or New Jersey.
And 32 more states have restricted who can prescribe the pills, the Associated Press reported, barring anyone other than a physician from writing a prescription.