In this photo illustration, a person is looking at an abortion pill (RU-486) for unwanted pregnancy from Mifepristone, shown on a smartphone on May 8, 2020 in Arlington, Virginia.
Olivier Doulieri AFP | Getty Images
Women in states that ban abortion will still be able to terminate unwanted pregnancies with abortion pills ordered online from abroad, even though the legal situation is murky and poses potential risks.
The Supreme Court on Friday overturned the remarkable 1973 Rowe v. Wade ruling that protected abortion as a constitutional right in the United States – allowing states to impose partial or complete bans on the procedure.
At least eight states immediately banned all forms of abortion, including medical abortions using pills, within hours of the Supreme Court ruling. Healthcare providers who perform abortions, and in some cases the people who help patients get the procedure, will face prosecution and years in prison. In Missouri, for example, anyone who has an abortion faces up to 15 years in prison.
However, the United States prohibits the persecution of women who have abortions, according to the text of legislation in eight states. Many women with unwanted pregnancies who are unable to travel outside the state for abortion are likely to terminate their pregnancies at home on their own with abortion pills purchased online through international health companies such as Aid Access.
“Under certain circumstances, it will be possible for women to get a medical abortion from these ISPs and manage their abortion on their own, so this will provide some people with some access, but not enough,” said Dr. Jen Villavicencio of the American College of Obstetricians. and gynecologists.
“People can, with the right information, safely manage their own abortion in the first trimester,” she said.
Aid Access is an international provider of telemedicine abortion, founded by Dutch doctor Rebecca Gomperts. Her European doctors provide online consultations and write prescriptions for abortion pills, which are then filled and mailed from a pharmacy in India.
Aid Access told CNBC it would continue to send pills to women in all US states, including those who banned the procedure. U.S. health care providers will be barred from prescribing and sending abortion pills to women in states that ban the procedure.
The abortion pill, mifepristone, is approved in the United States for termination of pregnancy before the 10th week of pregnancy. The Food and Drug Administration first approved the drug in 2000, but required women to receive it in person through a program that monitors certain drugs for safety risks.
Abortion advocates have fiercely criticized FDA requirements, arguing that mifepristone has long and proven experience as a safe and effective way to terminate an early pregnancy.
In response to last year’s Covid pandemic, the FDA suspended the requirement for women to receive the pill in person. In December, the drug regulator finally terminated the personal requirement, which will allow certified pharmacies in the United States to fill out and send prescriptions by mail.
Pill or abortion with drugs is becoming more common in the United States In 2020, more than 50% of abortions in the United States were with the pill, according to a study by all known providers of the Gutmacher Institute.
Telemedical barriers
Access to help will be one of the few options left for many women in the United States who have banned the procedure. The organization’s European doctors face little legal risk from state laws in the United States. However, health care providers in the United States that offer abortion pills through telehealth in states that have banned the procedure could potentially face legal consequences.
In telehealth, a patient’s location usually determines which laws must be followed, said Amanda Allen, senior counselor and director of the Advocacy Project. A health care provider in New York where abortion is legal, who offers the pill through telehealth to a patient living in Texas, will be subject to Texas law, Alan said. The provider could face criminal sanctions and their medical license could be subject to scrutiny, she said.
“Unfortunately, that will mean very, very few choices for people in these forbidden countries,” Allen said. “Telemedicine will not be an aid to the situation,” she said.
Boxes of Mifepristone, used to induce medical abortion, were prepared for patients at Planned Parenthood Health Center in Birmingham, Alabama, March 14, 2022.
Evelyn Hockstein Reuters
Abortion bans went into effect in Arkansas, Kentucky, Louisiana, Missouri, Oklahoma, South Dakota, Utah and Alabama on Friday. Idaho, Tennessee and Texas will introduce bans in 30 days. The bans in Mississippi, North Dakota and Wyoming will take effect after a certification process.
Almost all of these countries explicitly prohibit the prescribing or administration of any abortion drug, while in other countries the prohibitions are written so broadly that they include the pill.
“They all apply throughout pregnancy to any method of abortion, so drug abortion will not be available to people in those states,” said Elizabeth Nash, an expert on state abortion laws at the Guttmacher Institute. Women will have two options – to cross state borders or to order pills online.
“People are increasingly using online access,” Nash said, “but unfortunately we’ll see how many more people will seek care that way.”
Crossing state lines
Abortion advocates in the United States are finding ways for women to maintain access to abortion pills despite government bans.
Just The Pill, an online clinic in Minnesota that provides abortion pills through telemedicine, is setting up mobile clinics in states where abortion is legal, those border states where the procedure is banned or severely restricted. Patients will cross the border for consultation and the pill will then be mailed to an address, UPS access point or general delivery at a collection post office in the country where it is legal.
Just The Pill plans to launch a mobile clinic in Colorado later this month and bring a group of patients across the border from Texas, which had already banned abortion after the sixth week of pregnancy. Just The Pill sees New Mexico and Illinois as future sites for mobile clinics because they are close to states that have either already banned abortions or will do so soon.
The strategy carries legal risks. It is unclear whether states that have banned abortion will try to take action against providers in other states that offer the procedure to women crossing state borders.
“Our plan is to move to safe countries where abortion is constitutionally or otherwise protected, and to help people travel to those safe countries to provide care, knowing there will be a lot of legal risks,” he said. Dr. Julie Amaon, Medical Director at Just The Pill.
President Joe Biden and the U.S. Department of Justice, as a stern warning Friday to states banning abortion, said they would exercise all the powers at their disposal to protect women crossing state borders to receive the procedure in states. where abortion remains legal.
“If a government or local official, high or low, tries to prevent a woman from exercising her basic right to travel, I will do everything in my power to combat this deeply un-American attack,” Biden told the nation. . after the decision of the Supreme Court.
Online pharmacies
Websites like Plan C Pills also provide information on how patients find ways to get the abortion pill. In some cases, people arrange televised consultations in states such as California, where abortion is protected, through services that do not require a video visit, so they do not need to provide their location. They then set up a virtual mailbox on the Internet, send the abortion pill to that address, and then send the package to their home, according to Plan C’s website.
There are also several Internet companies that mail generic abortion pills directly to people’s addresses without a prescription or consultation. The drug costs from $ 200 to more than $ 400 depending on the website. Plan C ordered drugs from several of these companies, tested them in a lab and found them to be real abortion pills, said Eliza Wells, the group’s co-founder. Plan C published the results of its tests in the journal Contraception in 2017.
However, the pills have not been inspected by the FDA, so their safety and effectiveness are not guaranteed by a US regulator. It is also not clear who runs these companies and where in the world they are based. In the past, the FDA has tried to shut down such websites.
“There is never a guarantee, but based on our test purchases and initial lab tests, the sites we list on our website appear to provide genuine quality pills,” Wells said.
Dr Abigail Icon, a reproductive health expert at the University of Texas at Austin, said the pills from online websites would need to be tested regularly to ensure they were authentic. Icon said it was important to make sure the pills came in a blister pack that was properly sealed, as exposure to air could affect the effectiveness of the drug. She also said that the advantage of Aid Access, unlike other websites, is that they have a help team to answer patients’ questions and provide information about the process.
Aiken and Aid Access published a study in The Lancet in February that examined the records of nearly 2,800 people in the United States who used abortion pills prescribed by the group from March 2018 to 2019. About 96% of patients reported successful completion. your pregnancy without surgery. One percent of patients report a serious side effect when they need treatment, including blood transfusions and intravenous antibiotics. There are no reports of deaths.
Aid Access offers financial assistance to patients with a sliding scale, which usually ranges from …
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