There is an abortion method that doesn’t require surgery or anesthesia, and federal regulators say it can be safely performed at home: abortion medication.
Florida law prohibits physicians from prescribing the drugs online or over the phone — a practice that was approved by federal regulators in 2020 — but anti-abortion activists want to go further.
John Stemberger, president of the Christian conservative Florida Family Policy Council, said he expects the state’s Republican-led Legislature will consider a six-week ban in next year’s session if the U.S. Supreme Court overturns Roe v. Wade, the 1973 decision that found that women have the constitutional right to an abortion.
He believes GOP lawmakers should also focus on the medications that induce abortions at home, those who prescribe and dispense it and those who attempt to mail it to women across Florida.
“There should be a complete legal ban on all mail-order abortion drugs,” Stemberger said in an email to the Tampa Bay Times.
The state should also require additional certification for physicians, clinicians and pharmacists who wish to prescribe and dispense abortion drugs, he added. Abortion rights groups say they’re preparing for that scenario.
No abortion clinic needed
Nearly half of all abortions in Florida last year were performed using medication — among the highest rates in the country — according to federal health records. The treatment consists of two drugs taken over 48 hours: The first drug, mifepristone, terminates the pregnancy; and the second, misoprostol, helps the body expel it.
“It’s kind of like a really heavy, crampy period,” according to Planned Parenthood. Passing some blood clots is normal, as are nausea and a mild fever. Most symptoms should pass after about 24 hours.
The treatment is only an option in the first 10 weeks of pregnancy and cannot be performed on patients who have an intrauterine device (IUD); those with severe heart or lung disease and bleeding disorders; or those who take blood thinners or certain types of steroids.
The drugs allow people who have no access to an abortion clinic to undergo the procedure, said Melissa Simon, vice chairperson for research in the department of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine.
Balancing child care, work and school obligations makes visiting a clinic impossible for many pregnant people, she said. And those who live in rural areas or lack transportation may be unable to make repeated trips to see a physician.
Florida’s clinics are dwindling under state regulation, making access even harder. Since 1999, legislators have passed seven bills restricting abortion access. From 2011-2017, Florida lost seven abortion providers and the number of abortions declined by over 20%, according to the Guttmacher Institute, an abortion rights research organization.
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Visiting a clinic isn’t just time-consuming, Simon said, but it can also be intimidating. She remembers running the gauntlet of anti-abortion picketers outside the Chicago clinic where she regularly provides abortion services.
“It’s a scary experience,” she said, “having to go through the lines of protesters and being yelled at.”
Florida bans telehealth abortions
In 2020, the Food and Drug Administration ruled that patients no longer had to see a doctor in person to get abortion pills, saying that physicians could prescribe the drugs over the phone or online and that pharmacies can deliver the pills in the mail.
But for seven years Florida law has required patients to meet a physician in person at least 24 hours before taking the first pill. That eliminates medication abortion as an option for Floridians who cannot see a physician in person for any reason.
In-person visits allows physicians to offer counseling to pregnant people and identify underage girls or victims of rape or human trafficking, Stemberger said.
However, screening patients for medical conditions can be done over the phone or an online video call, Simon said. In her experience, she said, women who are victims of rape or trafficking often feel safer using telehealth services than visiting a clinic in person.
“There is absolutely zero medical reason or even scientific reason” to require an in-person visit, Simon said. “The rule just creates one more barrier.”
An international plan
Florida isn’t the only state to ban telehealth abortions: 18 other states have laws that either explicitly ban the practice or make them impossible to perform in compliance with other regulations, according to the Guttmacher Institute, an abortion rights organization.
But there are ways around the law and future restrictions, said Christie Pitney, a certified nurse midwife with Aid Access, an organization that provides telehealth appointments so people can obtain medication abortions in the U.S.
In states like Florida, Aid Access refers patients to Austrian physician Rebecca Gompers, who founded the organization. The medications are then packaged by an India-based pharmacy and delivered to the patient within one to two weeks.
Because Gompers and the online pharmacy are both outside state jurisdiction, the service would remain open to Florida residents even if the state banned abortions outright, Pitney said. Florida law only punishes abortion providers, not patients.
Aid Access vets their pharmacy providers, Pitney said. But Stemberger, the conservative activist, believes that telehealth visits and mail-order prescriptions will lead to medical complications.
“They can potentially sidestep all of the (state and federal regulatory) measures intended to protect the health and safety of the mother,” Stemberger said.
Simon, the Northwestern University physician, shares that concern — but believes that it’s riskier to deny access to legal abortion, including medication abortion.
If abortion is banned, she said, people without the means to travel will be forced to seek unsafe treatments. She fears that without regulation, the door opens to fraudsters marketing “fake pills that try to accomplish an abortion.”
Keeping abortion legal and accessible keeps out bad actors and protects mothers, Simon said.
“If Roe v. Wade is overturned, it doesn’t mean that abortion is gone,” she said. “It’s just going to be not safe.”
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