Some states target abortions done through medication
About 40% of all abortions in the U.S. are now done through medication — rather than surgery — and that option has become all the more pivotal during the COVID-19 pandemic. Abortion rights advocates say the pandemic has demonstrated the value of medical care provided virtually, including the privacy and convenience of abortions taking place in a woman’s home, instead of a clinic. Abortion opponents, worried the method will become increasingly prevalent, are pushing legislation in several Republican-led states to restrict it and in some cases, ban providers from prescribing abortion medication via telemedicine. Ohio enacted a ban this year, proposing felony charges for doctors who violate it. The law was set to take effect next week, but a judge has temporarily blocked it in response to a Planned Parenthood lawsuit. In Montana, Republican Gov. Greg Gianforte is expected to sign a ban on telemedicine abortions. The measure’s sponsor, Rep. Sharon Greef, has called medication abortions “the Wild West of the abortion industry” and says the drugs should be taken under close supervision of medical professionals, “not as part of a do-it-yourself abortion far from a clinic or hospital.” Opponents of the bans say telemedicine abortions are safe, and outlawing them would have a disproportionate effect on rural residents who face long drives to the nearest abortion clinic. “When we look at what state legislatures are doing, it becomes clear there’s no medical basis for these restrictions,” said Elisabeth Smith, chief counsel for state policy and advocacy with the Center for Reproductive Rights. “They’re only meant to make it more difficult to access this incredibly safe medication and sow doubt into the relationship between patients and providers.” Other legislation has sought to outlaw delivery of abortion pills by mail, shorten the 10-week window in which the method is allowed, and require doctors to tell women undergoing drug-induced abortions that the process can be reversed midway through — a claim that critics say is not backed by science. It’s part of a broader wave of anti-abortion measures numerous states are considering this year, including some that would ban nearly all abortions. The bills’ supporters hope the U.S. Supreme Court, now with a 6-3 conservative majority, might be open to overturning or weakening the 1973 Roe v. Wade decision that established the nationwide right to end pregnancies. Legislation targeting medication abortion was inspired in part by developments during the pandemic, when the Food and Drug Administration — under federal court order — eased restrictions on abortion pills so they could be sent by mail. A requirement for women to pick them up in person is back, but abortion opponents worry the Biden administration will end those restrictions permanently. Abortion-rights groups are urging that step. With the rules lifted in December, Planned Parenthood in the St. Louis region would mail pills for telemedicine abortions overseen by its health center in Fairview Heights, Illinois. A single mother from Cairo, Illinois, more than a two-hour drive from the clinic, chose that option. She learned she was pregnant just a few months after giving birth to her second child. “It wouldn’t have been a good situation to bring another child into the world,” said the 32-year-old woman, who spoke on the condition her name not be used to protect her family’s privacy. “The fact that I could do it in the comfort of my own home was a good feeling,” she added. She was relieved to avoid a lengthy trip and grateful for the clinic employee who talked her through the procedure. “I didn’t feel alone,” she said. “I felt safe.” Medication abortion has been available in the United States since 2000 when the FDA approved the use of mifepristone. Taken with misoprostol, it constitutes the so-called abortion pill. The method’s popularity has grown steadily. The Guttmacher Institute, a research organization that supports abortion rights, estimates that it accounts for about 40% of all abortions in the U.S. and 60% of those taking place up to 10 weeks gestation. “Beyond its exceptionally safe and effective track record, what makes medication abortion so significant is how convenient and private it can be,” said Megan Donovan, Guttmacher’s senior policy manager. “That’s exactly why it is still subject to onerous restrictions.” Planned Parenthood of Southwest Ohio, which includes Cincinnati, says medication abortions account for a quarter of the abortions it provides. Of its 1,558 medication abortions in the past year, only 9% were done via telemedicine, but the organization’s president, Kersha Deibel, said that option is important for many economically disadvantaged women and those in rural areas. Mike Gonidakis, president of Ohio Right to Life, countered that “no woman deserves to be subjected to the gruesome process of a chemical abortion potentially hours away from the physician who prescribed her the drugs. ” In Montana, where Planned Parenthood operates five of the state’s seven abortion clinics, 75% of abortions are done through medication — a huge change from 10 years ago. Martha Stahl, president of Planned Parenthood of Montana, says the pandemic — which increased reliance on telemedicine — has contributed to the rise in the proportion of medication abortions. In the vast state, home to rural communities and seven Native American reservations, many women live more than a five-hour drive from the nearest abortion clinic. For them, access to telemedicine can be significant. Greef, who sponsored the ban on telemedicine abortions, said the measure would ensure providers can watch for signs of domestic abuse or sex trafficking as they care for patients in person. Yet advocates of the telemedicine method say patients are grateful for the convenience and privacy. “Some are in a bad relationship or victim of domestic violence,” said Christina Theriault, a nurse practitioner for Maine Family Planning who can perform abortions under state law. “With telemedicine, they can do it without their partner knowing. There’s a lot of relief from them.” The group has health centers in far northern Maine where women can get abortion pills and take them at home under the supervision
Alabama just one of several states considering pro-life legislation
The Louisiana legislature is halfway toward passing a law — like the ones enacted in Mississippi and Georgia — that will ban abortions after a fetal heartbeat is detected, about six weeks into a pregnancy and before many women know they’re pregnant. Alabama is on the cusp of approving an even more restrictive bill. State governments are on a course to virtually eliminate abortion access in large chunks of the Deep South and Midwest. Ohio and Kentucky also have passed heartbeat laws; Missouri’s Republican-controlled legislature is considering one. Their hope is that a more conservative U.S. Supreme Court will approve, spelling the end of the constitutional right to abortion. “For pro-life folks, these are huge victories,” said Sue Liebel, state director for the Susan B. Anthony List, an anti-abortion advocacy group. “And I think they’re indicative of the momentum and excitement and the hope that’s happening with changes in the Supreme Court and having such a pro-life president.” For abortion rights supporters, meanwhile, the trend is ominous. Said Diane Derzis, owner of Mississippi’s sole abortion clinic, the Jackson Women’s Health Organization: “I think it’s certainly more dire than it ever has been. They smell blood and that’s why they’re doing this.” Already, Mississippi mandates a 24-hour wait between an in-person consultation. That means women must make at least two trips to her clinic, often traveling long distances. Other states have passed similar, incremental laws restricting abortion in recent years, and aside from Mississippi, five states have just one clinic — Kentucky, Missouri, North and South Dakota, and West Virginia. But the latest efforts to bar the procedure represent the largest assault on abortion rights in decades. Lawmakers sponsoring the bans have made it clear their goal is to spark court challenges in hopes of ultimately overturning the 1973 Roe v. Wade decision legalizing abortion. Those challenges have begun. Derzis’ attorneys are scheduled to go before a judge on May 21, seeking to prevent Mississippi’s heartbeat law from taking effect July 1. A judge in Kentucky blocked enforcement of that state’s heartbeat ban after the American Civil Liberties Union filed suit on behalf of the clinic in Louisville. Similar legal action is expected before bans can take effect in Ohio and Georgia, where Republican Gov. Brian Kemp signed the latest heartbeat bill into law Tuesday. Kemp said he welcomed the fight, vowing: “We will not back down.” Georgia’s ban doesn’t take effect until Jan. 1. But the impact was immediate.An abortion clinic operated by The Women’s Centers in Atlanta began receiving anxious calls from patients soon after Kemp signed the law. Many callers had plans to travel from outside the state for abortions. Georgia’s heartbeat ban would have a wider impact because the state has 17 abortion clinics — more than the combined total in the other four Southern states that have passed or are considering bans. “On a typical day we will see people from North Carolina, Tennessee, Alabama, South Carolina — all over the region,” said Dr. Lisa Haddad, the Atlanta clinic’s medical director. “And my thought is we’re not going to see those people coming here because they assume it’s already illegal in Georgia.” Dr. Ernest Marshall, co-founder of Kentucky’s last remaining abortion clinic in Louisville, said in an email that banning abortions before most women know they’re pregnant would “have a disproportionate impact on poor women and communities of color throughout the South.” Advocates for abortion rights expect judges to halt enforcement of any new bans while lawsuits work their way through the courts. That could take years. “These laws are blatantly unconstitutional,” said Elisabeth Smith, chief counsel for state policy and advocacy for the Center for Reproductive Rights, which also has filed suit over Mississippi’s ban. “But if they were allowed to go into force, they would have devastating consequences for the residents of all of these states.” If heartbeat bans are upheld, many women who are poor and have limited means to travel would have few options other than to try to terminate their own pregnancies, Haddad said, possibly using abortion drugs purchased online. Others would have to drive or fly across multiple states, said Elizabeth Nash, a state policy analyst for the Guttmacher Institute, a research group that supports abortion rights. “People would go to Florida, people would continue to go to Memphis,” Nash said. “How many states do you have to cross before you can access abortion services? It exacerbates all the issues we’ve already seen around taking time off from work and having the money to travel.” Proposed heartbeat bans failed to pass this year in several Republican-led states, including Texas. There, GOP lawmakers lost ground to Democrats in the 2018 elections, and some abortion foes were wary after courts struck down prior abortion restrictions in the state. Such efforts also fell short in Florida, South Carolina, Tennessee and West Virginia. Alabama lawmakers postponed until next week a vote on a proposal that would make performing nearly all abortions a felony. The measure has passed the state House, and the Senate suspended debate Thursday amid a heated dispute over whether exemptions for rape and incest should be stripped from the bill. “You can’t put a price on unborn life,” Eric Johnston, president of the Alabama Pro-Life Coalition, said Wednesday, as a legislative committee heard testimony on the state’s proposed ban. “What you have to do is protect the people that live in this state and that includes unborn children.” But Jenna King-Shepherd told Alabama lawmakers she believed the abortion she had at age 17 allowed her to finish college. She said her father, a part-time Baptist preacher furious about her pregnancy, drove her to the abortion clinic because he trusted her to make the right choice. “I’m not asking you to support access to abortion,” King-Shepherd said. “I’m only asking you to let women, their families, their physicians and their God make this decision on how they want to start their families in private and trust them to do that.” Republished
