The next front in the Abortion conflict

With Roe v. Wade about to be either officially overturned next year, or, at minimum, functionally eviscerated, abortion policy is going to be a state-by-state issue.  And, in many states the new front line may well be the issue of medical abortion.  Expect to see lots of political and policy conflict here after the Court decision.  NYT with details:

The federal government on Thursday permanently lifted a major restriction on access to abortion pills. It will allow patients to receive the medication by mail instead of requiring them to obtain the pills in person from specially certified health providers.

The decision, by the Food and Drug Administration, comes as the Supreme Court is considering whether to roll back abortion rights or even overturn its landmark 1973 decision in Roe v. Wade that made abortion legal nationwide.

The F.D.A.’s action means that medication abortion, an increasingly common method authorized in the United States for pregnancies up to 10 weeks’ gestation, will become more available to women who find it difficult to travel to an abortion provider or prefer to terminate a pregnancy in their homes. It allows patients to have a telemedicine appointment with a provider who can prescribe abortion pills and send them to the patient by mail.

Earlier this year, for the duration of the pandemic, the F.D.A. temporarily lifted the in-person requirement on mifepristone, the first of two drugs used to end a pregnancy. The decision to make this change permanent is likely to deepen the already polarizing divisions between conservative and liberal states on abortion. In 19 states, mostly in the South and the Midwest, telemedicine visits for medication abortion are banned, and these and other conservative states can be expected to pass other laws to further curtail access to abortion pills.

Yet other states, like California and New York, which have taken steps in recent years to further solidify access to abortion, are expected to increase the availability of the method and provide opportunities for women in states with restrictions to obtain abortion pills by traveling to a state that allows them.

“It’s really significant,” said Mary Ziegler, a law professor at Florida State University. “Telehealth abortions are much easier for both providers and patients, and even in states that want to do it, there have been limits on how available it is.”

Groups that want to outlaw abortion issued strong statements against the decision.

“The Biden administration today moved to weaken longstanding federal safety regulations against mail-order abortion drugs designed to protect women from serious health risks and potential abuse,” said a statement from the group Susan B. Anthony List. “The Biden administration policy allows for dangerous at-home, do-it-yourself abortions without necessary medical oversight.”

Let’s just pause here for a moment to deride the pro-life’s side completely bad-faith, risible argument that this about protecting women’s health.  Just own it and say “we are in favor of anything that makes it harder to take unborn life” or whatever along the lines. I just hate these completely fallacious arguments that this is in any way about women’s health.  Continuing…

So far this year, presumably in anticipation of such a decision, six states banned the mailing of pills, seven states passed laws requiring pills to be obtained in person from a provider, and four states passed laws to set the limit on medication abortion at earlier than 10 weeks’ gestation, said Elizabeth Nash, the interim associate director of state issues for the Guttmacher Institute, a research organization that supports abortion rights.

Susan B. Anthony List said in its statement that next year, at least seven additional states were likely to enact laws restricting the method.

The current practice is that women who live in states that don’t allow telemedicine for abortion must travel to a state that does — although they don’t have to visit a clinic. They may be in any location within that state for their telehealth visit, even a car, and may receive the pills at any address in the state.

But legal experts said they expected supporters of abortion rights to try to find ways to make the pills available without requiring a patient to travel, including possibly filing legal challenges to state laws banning telemedicine for abortion…

“There’s going to be plenty of people who try to use them in states where they’re illegal without traveling out of state, legal ramifications aside,” said Professor Ziegler. She said such efforts might include clearinghouses that would try to allow “fudging where people’s addresses are to receive it” and a “black market” that might emerge.

In data released last month by the Centers for Disease Control and Prevention, 42 percent of all abortions — and 54 percent of abortions before 10 weeks — occurred with medication in 2019, the most recent year for which C.D.C. data is available. (The report represents most of the country, but does not include data from California, Maryland and New Hampshire.)

In 2020, in some states, including Indiana, Kansas and Minnesota, the method accounted for a majority of abortions, according to state health department reports.

The C.D.C. also reported that 79 percent of all abortions occurred before 10 weeks’ gestation, suggesting that there are many more women who might choose abortion pills over an in-clinic procedure if they could.

There’s also the fact that these drugs essentially induce a miscarriage.  Sadly, this means in many states the trauma of having a miscarriage will only be compounded.  Jessica Grose:

When you have your first bad sonogram, you fall into an abyss of maternity care. If you haven’t experienced it, you might not know the contours of this purgatory, but I can tell you what it’s like. Almost exactly seven years ago, the face of my obstetrician fell while performing an ultrasound for a very wanted pregnancy, and our collective mood shifted in an instant from buoyant to somber.

I learned that day that it appeared that my pregnancy was not progressing, because my doctor couldn’t find a heartbeat. But he couldn’t be certain; my period was quite irregular, and it was possible that he misdated the pregnancy and that it was still viable. So I had to wait. One week, then two. Dragging myself into the radiologist’s office every few days to see if there was a heartbeat while attempting to work and parent my then-2-year-old and desperately trying not to cry most of my waking moments.

When my doctors were finally certain that the pregnancy would not go forward, I was given three options: I could continue to wait and see if my body would miscarry on its own without intervention, I could take medication and end the pregnancy at home, or I could have a surgical procedure to empty my uterus, known colloquially as a D. and C. (The last two options are the same choices offered to abortion patients.)

I chose the D. and C., mainly because I wanted to get this awful experience over with as soon as possible.

 Years later, I am at peace with the pregnancy loss; the fetus had a chromosomal issue called Turner syndrome, which “may cause up to 10 percent of all first-trimester miscarriages,” according to the National Institutes of Health. I know now that miscarriages are common. An estimated one-quarter of all pregnancies and around 10 percent of known pregnancies end in miscarriage before 20 weeks. Thankfully, I was able to have another healthy child later. But that two-week wait remains painful to think about.

And yet I’m thinking about it in the aftermath of the Supreme Court’s ruling on Friday allowing federal court challenges to Texas’ restrictive abortion law, S.B. 8, but leaving the law in effect, essentially outlawing abortions after six weeks in that state. That’s because in countries where elective abortion is outlawed or extremely restricted, women are not given the choices I had when they miscarry.

Abortion restrictions create a chilling effect on medical professionals who are understandably concerned about being prosecuted for anything resembling elective abortion. And so doctors in countries with restrictive laws “don’t always provide all the relevant information concerning the pregnancy, especially if they see there are complications and they’re afraid women can take drastic measures,” said Irene Donadio, a senior adviser at the International Planned Parenthood Federation.

I asked Dr. Isabel Stabile, a gynecologist in private practice in Malta and an abortion-rights activist, what first-trimester miscarriage care looks like in her country, where there is a total ban on abortion, with no exceptions. “The short answer to this question is in Malta it’s always a wait and see. Women are never given the immediate option of being hospitalized and having a D. and C. nor having pills so we can proceed with a spontaneous miscarriage. The medical and surgical options are never offered as a first line,” she said…

In cases like mine, when there is no detectable heartbeat, the trauma may primarily be to women’s mental health. But when there isa detectable heartbeat and there are other pregnancy complications, there are physiological stakes, including that women can and have died. In Poland, which has some of the strictest abortion laws in Europe, a 30-year-old woman named Izabela died of septic shock this year in Pszczyna after doctors declined to intervene to save her life. The fetus’s heart was still beating, so physicians may have been afraid to break the country’s laws because the penalty is spending three years in prison, according to reporting in The Guardian…

If you think this wouldn’t happen in the United States, think again, because there is evidence that it is already happening. At Catholic hospitals, which are expected to follow directives set by the U.S. Conference of Catholic Bishops to never allow abortion services, women may not be getting the full slate of medical options when they present with an ectopic pregnancy.

In September, Ghazaleh Moayedi, an obstetrician-gynecologist in Texas, sounded the alarm in these pages. “Pregnancies that face complications will now be at greater risk. Under this new law, the only abortion exception allowed is for a medical emergency. That might mean if a woman will imminently lose an organ or die without intervention. But how we judge that risk will play out individually with each hospital’s policy, in each clinic,” she wrote. “I can think of no other area of health care in which we would wait for someone to worsen nearly to the point of death before we offered intervention. It’s just unconscionable.”

I honestly think many and probably most opponents of legal abortion have good-faith religious/moral objections that lead them to this political position.  Heck, I used to hold similar positions myself. But, the sad reality is that trying to implement these particular moral beliefs through public policy is ultimately injurious not only to women’s autonomy, but to women’s health and that’s a tradeoff we should not be making.