The evidence was coming in mailing of pills and telehealth for medication abortion is safe and effective. Medication abortion itself is safe and effective.
Elizabeth Nash (14:47)
In this episode:
The hosts open with what they’re pissed about (02:06)
Carol introduces our guest, Elizabeth Nash (06:28)
The State of the Union in terms of abortion access (08:38)
How medication abortions work (13:30)
What individuals, governments, physicians, prosecutors, politicians, businesses, and philanthropists can do (21:53)
The Hosts Start by Sharing What They’re Pissed About
Carol is pissed that a 15-year-old was arrested by the Washington DC police for a mass shooting on Juneteenth. Three people were wounded, and a 15-year-old boy named Chase Poole was killed in the shooting.
Gloria is pissed that men get the benefit of the doubt, even when they have a history of bad behavior. Adam Neumann got more venture capital after crashing WeWork, when women have overprove themselves in the business and political worlds. Additionally, Gloria talks about the “crudite-gate” ad, saying that Mehmet Oz is behind the times and out of touch. However, this gaffe has led to increased support for his opponent, Democrat John Fetterman.
Betty is pissed about “the prevalent death of logic and common sense in our country.” This week, a Florida court ruled a 16-year-old girl is not mature enough to have an abortion, even though she took to educate herself about the procedure and get the proper permissions through the court. However, she was denied and now will be forced to carry the pregnancy to term.
Sherrye is pissed that a 17-year-old in Nebraska was charged for getting a medical abortion in violation of Nebraska’s state law. Her mother is also facing charges for helping her acquire the medication.
Our guest, Elizabeth Nash, is pissed about how quickly the states are banning abortion and the levels of prosecutorial action that we see taking place.
A General View of Abortion in America
We have 14 states where abortion is banned, and in Wisconsin, the law is so confusing that providers have stopped offering care. This affects more than 20 million people of reproductive age that don’t have access to services they need. A lot of bans are regionally clustered, so huge swaths of women in the country are facing a lack of access.
Patients looking for in-clinic care face scheduling dates that are three to four weeks out, which is a crucial time period in the pregnancy. Costs are around $550 for just the medication or the procedures. Those costs continue to increase when you consider:
- Travel to a state where abortion is protected (gas, hotel, food)
- Arranging childcare, since more than 60% of people who have abortions already have children
- Taking time off of work, which is unpaid for many seeking care
It boils down to the fact that rich people – generally rich, white women – will be able to access abortion care, and people who are pregnant, low income, Black and Brown patients, young patients, LGBTQ patients will have a much harder time getting an abortion. So that’s really what we’re looking at right now.
Elizabeth Nash (11:08)
The Impact of Roe Being Overturned and Medication Abortions
According to the latest statistics, over 50% were done with medication. Those numbers are from 2020, but that number is expected to rise with the Dobbs decision. It’s expected that the demand will increase dramatically. This is based off of the fact that when the six-week ban went into effect in Texas in September 2021, calls around medical abortions skyrocketed, even though at the time, Roe was still the law of the land.
The FDA approved medical abortions in the fall of 2000, and over the last 20 years, more and more people are using the pills in a non-clinical setting. Sites like Aid Access can help provide medical abortion access via the mail. Those in need can go through their website to get support.
How Medication Abortions Work
*Note: No one speaking on this episode is a medical doctor, and this information should not be taken as medical advice.
According to the common protocol in the US right now, there are two drugs involved in a medical abortion:
- Mifepristone: stops the pregnancy from developing
- Misoprostol: evacuates the fetus
Now pills can be sent through the mail, and telehealth support is a great way to ensure access. Most medications are taking place within the first trimester. However, there are regiments that are safe into the second trimester.
Medication abortions done via the mail are only 60% of the cost of an in-clinic abortion, and travel and other associated costs are decreased significantly, as well. Typically, these pills are able to take place up to 10 weeks, although there are certain protocols that can go into the second trimester.
How These Restrictions Impact Medication Abortions
Typically, the restrictions exempt the pregnant person from criminal penalties, but that doesn’t mean that patients aren’t impacted by them. Since states are banning mailing of pills in direct response to the FDA’s approval of mailing and telehealth, restrictions are being made simply to limit access.
States are saying that a provider must be present, saying that it is safer to have the provider in the room. Science and evidence say this isn’t the case. Further restrictions in some states are now coming around that requires pregnant people to take the first dose in the room. This could cause the process to begin when the pregnant person is heading back home, instead of taking the medication in their chosen place with safety and support in place. Additionally, some states are trying to require licensing for manufacturers and distributors of these pills.
All of this piles up to create barriers to access for millions of people across the country.
What We All Need to Do
All of us need to support abortion funds and practical support groups, which help people physically get to states where they need to go and help facilitate online access to those patients who might benefit from it. They also provide education for everyone and actively try to stop the spread of misinformation. Many people aren’t aware that abortion rights have gone back to the state level, but they instead think abortion is banned in all of the United States.
Organizations like If/When/How offer legal information, helplines, and attempt to change the legal landscape.
What Governments Need to Do
While President Biden did sign some executive orders regarding abortion access, Elizabeth thinks the federal government needs to do more. There are cases that the federal government has filed around EMTALA, which was enacted in 1986 and requires everyone receive access to emergency care. These cases are being used to ensure that medical emergencies around abortion, miscarriage, and pregnancy are treated accordingly.
What the Medical Community Needs to Do
Elizabeth says that “we desperately need a road map” because the states are not uniform. The medical community can help develop protocols on what causes and constitutes emergencies in these scenarios. This would help prevent critical situations around pregnancy, and these bills are designed to create critical situations. A road map like this from the medical community would give providers the ability to actually treat their patients.
What Prosecutors Need to Do
Since prosecutors have leeway in which cases they take, they do have discretion on whether or not to bring criminal charges against people. However, anti-choice prosecutors can use other laws, such as practicing medicine without a license or fetal homicide, in order to punish those who help patients self-administer an abortion. Pro-choice prosecutors can and will refuse to try these sorts of cases.
Our resident historian, Gloria Feldt, notes a “historical bookend” that she sees around Comstock Laws. The Comstock Laws were passed in 1873 and “criminalized any use of the U.S. Postal Service to send any of the following items: obscenity, contraceptives, abortifacients, sex toys , personal letters with any sexual content or information, or any information regarding the above items.” Governor Pritzker of Illinois asked President Biden to ensure that no one would be prosecuted for sending these medications through the mail.
What Congress Needs to Do
There are many things that Congress can do. The Women’s Health Protection Act could be passed. The EACH Act focuses on removing the Hyde Amendment, but it stalls out. There have been attempts to change the federal budget in order to create better access to abortion care. However, the lack of support in the Senate means that a lot of these efforts are eventually squashed.
This is leading some states to invest massive amounts into abortion care, but it’s not sustainable in the long term. It also doesn’t solve the problem for residents of other states who aren’t investing those funds into abortion care.
That’s why it’s critical to vote for pro-choice senators in the midterm elections on November 8th.
What Businesses Need to Do
It’s critical for activists and organizations, like Rhia Ventures, to make businesses understand that they can do good by supporting abortion rights without jeopardizing their business. If corporations will pay for travel for their employees, as some have offered to do, the corporations have a responsibility to protect everyone, not just those who happen to work for their company. Businesses has a huge role to play in impacting the decisions of state legislators.
What Philanthropists Need to Do
The Guttmacher Institute published a piece in The Chronicle of Philanthropy which urged those interested in philanthropy to focus on abortion access.
Elizabeth Nash
Elizabeth Nash is the Principal Policy Associate, State Issues with the Institute’s Public Policy office in Washington, DC. She works on a wide range of reproductive health policy issues, including abortion, contraception, insurance coverage, pregnancy and maternal health, fetal issues, refusal clauses, youth, and sex education. This work contributes to the Guttmacher’s State Laws and Policies series and updates of state policy developments. Elizabeth joined the Institute in 1999. She received her undergraduate degree from the College of William and Mary in 1996 and earned a master’s degree in public policy from the George Washington University in 2005.