Boxes of the drug mifepristone sit on a shelf at the West Alabama Women's Center in Tuscaloosa, Alabama on March 16, 2022. A new survey puts a number to how often medical providers in states with laws that seek to protect them from prosecution are prescribing abortion pills to women in states with abortion bans or limits on prescribing the bills by telehealth. AP Photo / AP / Allen G. Breed
Boxes of the drug mifepristone sit on a shelf at the West Alabama Women's Center in Tuscaloosa, Alabama on March 16, 2022. A new survey puts a number to how often medical providers in states with laws that seek to protect them from prosecution are prescribing abortion pills to women in states with abortion bans or limits on prescribing the bills by telehealth. AP Photo / AP / Allen G. Breed
Thousands of women in states with abortion bans and restrictions are receiving abortion pills in the mail from states that have laws protecting prescribers, a new report shows.
Tuesday’s release of the #WeCount survey shows about 8000 women a month in states that severely restrict abortion or placelimits on having one through telehealth were getting the pills by mail by the end of 2023, the first time a number has been put on how often the medical system work-around is being used. The research was conducted for the Society of Family Planning, which supports abortion rights.
An additional 8000 women in states without bans or major restrictions on telehealth abortion were receiving pills each month through virtual appointments, the study showed.
In all, the survey counted about 90,000 monthly surgical or medication abortions offered by medical providers in 2023, higher than the previous year. Another study recently found close to two-thirds of the total use pills.
The group found by December 2023, providers in states with the protections were prescribing pills to about 6000 women a month in states where abortion was banned at all stages of pregnancy or once cardiac activity can be detected - about six weeks, often before women realise they’re pregnant. The prescriptions also were going to about 2000 women a month in states where the local laws limit abortion pill prescriptions by telemedicine.
“People ... are using the various mechanisms to get pills that are out there,” Drexel University law professor David Cohen said. This “is not surprising based on what we know throughout human history and across the world: People will find a way to terminate pregnancies they don’t want”.
Medication abortions typically involve a combination two drugs: mifepristone and misoprostol. The rise of these pills is one reason total abortion numbers increased even after the Supreme Court overturned Roe v. Wade in 2022.
A Pew Research Center poll conducted in April found Americans are substantially more likely to say medication abortion should be legal, rather than illegal, in their state. According to the poll, which didn’t look at laws protecting prescribers, more than half of US adults think medication abortion should be legal in their state, a fifth of them say it should be illegal, and about a quarter say they aren’t sure.
After Roe was overturned, abortion bans took effect in most Republican-controlled states. Fourteen states now prohibit it with few exceptions, while three others bar it after about six weeks of pregnancy.
But many Democratic-controlled states went the opposite way. They’ve adopted laws intended to protect people in their states from investigations involving abortion-related crimes by authorities in other states. By the end of last year, five of those states - Colorado, Massachusetts, New York, Vermont and Washington - had such protections in place specifically to cover abortion pill prescriptions by telemedicine.
People march through downtown Amarillo to protest a lawsuit to ban the abortion drug mifepristone. Photo / AP
“If a Colorado provider provides telehealth care to a patient who’s in Texas, Colorado will not participate in any Texas criminal action or civil lawsuit,” Cohen said. “Colorado says: ‘The care that was provided in our state was legal. It follows our laws because the provider was in our state.’”
Wendy Stark, president and CEO of Planned Parenthood of Greater New York, called the shield law there “a critical win for abortion access in our state”.
James Bopp Jr, general counsel for the National Right to Life Committee, said the law where the abortion takes place - not where the prescriber is located - should apply in pill-by-telemedicine abortions. That’s the way it is with other laws, he said.
But unlike many other aspects of abortion policy, this issue hasn’t been tested in court yet.
Bopp said the only way to challenge a shield law in court would be for a prosecutor in a state with a ban to charge an out-of-state prescriber with providing an illegal abortion.
“It’ll probably occur, and we’ll get a legal challenge,” Bopp said.
Researchers note before the shield laws took effect, people were obtaining abortion pills from sources outside the formal medical system, but it’s not clear exactly how many.
Alison Norris, an epidemiologist at Ohio State University and a lead researcher on the #WeCount report, said the group is not breaking down how many pills were shipped to each state with a ban “to maintain the highest level of protection for individuals receiving that care and providers providing that care”.
Dr. Rebecca Gomperts, director of Aid Access, an abortion pill supplier working with US providers, said having more shield laws will make the healthcare system more resilient.
“They’re extremely important because they make doctors and providers ... feel safe and protected,” said Gomperts, whose organisation’s numbers were included in the #WeCount report. “I hope what we will see in the end is that all the states that are not banning abortion will adopt shield laws.”
