Updated Jun 23, 2022 - Politics & Policy
Axios Explains: Abortion

Red states crack down on abortion pills

Where access to abortion pills prescribed via telemedicine is banned
Data: Guttmacher and Axios research; Map: Jacque Schrag/Axios

As the Supreme Court considers potentially overturning Roe v. Wade, abortion rights activists are heralding abortion pills as a potential option in places where clinics may have to close — but several red states are already cracking down on the pills.

The big picture: Almost half of U.S. states have banned or tightly restricted abortion pills — two medicines named mifepristone and misoprostol — and more could soon follow suit.

  • Prior to the pandemic, the FDA said patients seeking abortion pills had to get the drug from hospitals or medical facilities in person.
  • The FDA in December changed its guidance on abortion pills, permanently allowing people to access the medication through telemedicine and receive the pills by mail, where permitted by state law.

The latest: The Louisiana governor in June signed a law making it illegal for anyone to mail abortion pills, punishable by up to five years in prison and a $50,000 fine.

  • In Tennessee, the governor signed a law in May making it a felony to mail abortion pills, with a penalty of 20-year imprisonment and a $50,000 fine. The law also adds further restrictions to medication abortion.
  • Texas and Indiana are the only two states that ban the use of abortion pills at seven weeks and 10 weeks, respectively. So do South Dakota, Oklahoma and Montana, though courts have blocked those laws.
  • Republican lawmakers in several states have moved to introduce legislation aimed at making abortion pills illegal.
    • There's a bill moving through the Alabama legislature that would make it a crime to "manufacture, distribute, prescribe, dispense, sell, or transfer" abortion pills in the state.
  • The Wyoming state Senate passed a bill in March aimed at completely outlawing abortion pills.
  • In Iowa and Ohio, laws require a physician to be present when a patient takes the medication. However, federal judges blocked those laws , saying the requirement places an "undue burden" on women.

Of note: South Dakota Gov. Kristi Noem (R) attempted to prohibit the mailing of abortion pills via executive order instead of a legislation. However, a federal court temporarily blocked it.

  • People in the state are still required to see a health provider when looking to access the pill, which is given in a two-dose regimen. They are allowed to take the second dose at home.
  • In March, Noem signed into law a bill to add more restrictions to medication abortion access. It is set to take effect if the state can convince the court to overturn its block on the governor's order.

What they're saying: "I think pretty much any state that is on the conservative side might expect to see similar legislation in 2022," Elizabeth Nash, state policy expert at the Guttmacher Institute, told Axios.

What's next: Some activists have been pointing to newer options that skirt certain telemedicine restrictions and operate in a legal gray area, including one online medication abortion provider, Aid Access, founded by a Dutch physician in 2018, which will mail abortion pills internationally.

  • Abortion rights advocates say people who want to end a pregnancy will use abortion pills no matter what the policy landscape is.
  • "It is going to be in their hands in the U.S., it's inevitable," said Elisa Wells, co-founder of Plan C, which provides information on how to access abortion pills online. "This is modern medical technology everybody should have access to. Whether people can use it under the radar without being criminalized is the question."

The other side: "Pro-life groups are encouraging states to take action to install safeguards for women that will ensure they are aware of the risks when undergoing a chemical abortion," said Prudence Robinson, a communications associate at Susan B. Anthony List, an anti-abortion advocacy group.

  • "And the states are facing this threat head on. In this year alone, nearly 10 states enacted state-level restrictions on this dangerous method of abortion."

By the numbers: Medication abortion accounted for 54% of all U.S. abortions in 2020, an increase from 39% in 2017, according to the Guttmacher Institute.

Go deeper: Pills are the next big abortion battleground

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