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Access to Medication Abortion: Now More Important Than Ever
Published online by Cambridge University Press: 30 January 2023
Abstract
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References
1 Much of this note was written before the recent case, Dobbs v. Jackson Women’s Health Org., 141 S. Ct. 2619 (2021). The case concerned a Mississippi law which prohibits all abortions after fifteen weeks gestational age with few exceptions. The Court not only upheld the law but explicitly overruled Roe v. Wade, 410 U.S. 113 (1973) and Planned Parenthood of Southeastern Pennsylvania. v. Casey, 505 U.S. 833 (1992), uprooting decades of established precedent and protections for pregnant people seeking abortions. Many states are now attacking abortion rights and so data is still developing related to state abortion law statuses. The following data is current as of August 26, 2022.
2 Medication Abortion, Guttmacher Inst., https://www.guttmacher.org/evidence-you-can-use/medication-abortion [https://perma.cc/GBU3-CBHY] (last visited Mar. 22, 2021).
3 Id.
4 See id.
5 Id.
6 Heather D. Boonstra, Medication Abortion Restrictions Burden Women and Providers – and Threaten U.S. Trend Toward Very Early Abortion, Guttmacher Inst. (Mar. 19, 2013), https://www.guttmacher.org/gpr/2013/03/medication-abortion-restrictions-burden-women-and-providers-and-threaten-us-trend-toward [https://perma.cc/9UWG-NSZA]; see Medication Abortion, supra note 2.
7 In this paper, the term “prescribe” means to order a drug for use by a particular patient. The term “administer” means to cause to take. When I say “administer” I am referring to the process of a clinician giving the medication and/or the patient receiving the medication, and the patient taking the medication.
8 Id.
9 See Dan Keating et al., In These States, Pandemic Crisis Response Includes Attempts to Stop Abortion, Wash. Post (Apr. 23, 2020), https://www.washingtonpost.com/nation/2020/04/21/these-states-pandemic-crisis-response-includes-attempts-stop-abortion/?arc404=true [https://perma.cc/6MGN-J3MX].
10 See Rachel Rebouché, Assuring Access to Abortion 120 (Temple Univ. Beasley Sch. L. Legal Stud. Rsch. Paper Series ed., 2020).
11 Id.
12 Expanding Telemedicine Can Ensure Abortion Access During COVID-19 Pandemic, Ctr. for Reprod. Rts. & Colum. Mailman Sch. of Pub. Health (2020), https://reproductiverights.org/sites/default/files/documents/Expanding%20Telemedicine%20Can%20Ensure%20Abortion%20Access%20During%20COVID-19%20Pandemic.pdf [https://perma.cc/46DN-L4PL].
13 Liz Borkowski et al., Medication Abortion: Overview of Research & Policy in the United States 2 (2015), https://publichealth.gwu.edu/sites/default/files/Medication_Abortion_white_paper.pdf [https://perma.cc/GT2S-LXHM].
14 Medication Abortion, supra note 2.
15 Borkowski et al., supra note 13; The Availability and Use of Medication Abortion, Kaiser Family Found. (June 8, 2020), https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/ [https://perma.cc/B8MJ-K3A8].
16 Borkowski et al., supra note 13.
17 Id.
18 The Availability and Use of Medication Abortion, supra note 16.
19 Id.
20 Medication Abortion, supra note 2.
21 Id.
22 U.S. Food & Drug Admin., Mifeprex (mifepristone) Information (2021), https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information [https://perma.cc/XXS8-GXXE]; Medication Abortion, supra note 2.
23 Id probably
24 Medication Abortion, supra note 2.
25 Rachel K. Jones & Heather Boonstra, The Public Health Implications of the FDA’s Update to the Medication Abortion Label, Health Affs.: Forefront (June 30, 2016), https://www.healthaffairs.org/do/10.1377/hblog20160630.055639/full/ [https://perma.cc/Y228-KUQ3].
26 Medication Abortion, supra note 2.
27 Id.
28 U.S. Food & Drug Admin., supra note 23.
29 Id.; Medication Abortion, supra note 2.
30 Medication Abortion, supra note 2.
31 Id.
32 U.S. Food & Drug Admin., supra note 23.
33 Id.
34 Id.
35 Id.
36 Roe, 410 U.S. at 153, 163-64 (holding that in the first trimester, the decision could be made without any regulation by the state; in the second trimester, the states could regulate the abortion procedure to the extent that the regulation was reasonably related to maternal health; and in the third trimester, once the fetus became “viable,” states could regulate the abortion procedure or prohibit it altogether, as long as there were exceptions for the preservation of life or health of the mother).
37 See Casey, 505 U.S. at 878; see also Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292, 2300 (2016).
38 See id.
39 Hellerstedt, 136 S. Ct. at 2296; Casey, 505 U.S. at 877-78.
40 Throughout this paper, I refer to pregnant people as women because many state health policies and abortion restrictions, as well as court decisions, discuss “women’s health.” However, it is important to note that people of many different gender identities can become pregnant and are affected by abortion restrictions. By using the term “women” I do not mean to exclude the population of pregnant people who do not identify as women.
41 June Medical Servs. v. Russo, 140 S. Ct. 2103, 2112-13 (2020).
42 Linda Greenhouse & Reva B. Siegel, Casey and the Clinic Closings: When “Protecting Health” Obstructs Choice, 125 Yale L.J. 1428, 1430 (2016).
43 Medication Abortion, supra note 2.
44 Greenhouse & Siegel, supra note 42; see Planned Parenthood of Greater Tex. Surgical Health Servs. v. Abbott, 748 F.3d 583, 594 (2014).
45 See, e.g., Whole Woman’s Health v. Jackson, 142 S. Ct. 522 (2021); Dobbs v. Jackson Women’s Health Org., 141 S. Ct. 2619, 2619 (2021).
46 Jackson, 142 S. Ct. at 522-52.
47 Tex. Health & Safety Code Ann. §§ 171.204(a), 171.208(a)(2) (West 2021).
48 Jackson, 142 S. Ct. at 522-52.
49 Dobbs v. Jackson Women’s Health Org., 597 U.S. ___, 5 (2022) (“We hold that Roe and Casey must be overruled.”).
50 Id.; Miss. Code Ann. § 41-41-191 (2018).
51 Dobbs, 597 U.S. at 5.
52 Id.
53 Medication Abortion, Guttmacher Inst. (Jan. 1, 2022), https://www.guttmacher.org/state-policy/explore/medication-abortion [https://perma.cc/7LRJ-DPFX].
54 Id.
55 Id.
56 Olivia Cappello, Unproven, Unethical and Dangerous: Counseling Requirements on Stopping a Medication Abortion Threaten Patients and Providers, Guttmacher Inst. (Dec. 16, 2019), https://www.guttmacher.org/article/2019/12/unproven-unethical-and-dangerous-counseling-requirements-stopping-medication [https://perma.cc/RY3F-GN4Q].
57 U.S. Food & Drug Admin., Questions and Answers on Mifeprex (2019), https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex [https://perma.cc/S3CF-V4HY].
58 Medication Abortion, supra note 2.
59 Id.
60 See, e.g., Little Rock Fam. Plan. Servs. v. Rutledge, 397 F. Supp. 3d 1213, 1276 (E.D. Ark. 2019).
61 See id.
62 See id. at 1321.
63 Id. at 1315.
64 See id. at 1319.
65 See Little Rock Fam. Plan. Servs. v. Rutledge, 984 F.3d 682, 691 (8th Cir. 2021).
66 Medication Abortion, supra note 53.
67 Rebouché, supra note 10.
68 Megan K. Donovan, Improving Access to Abortion via Telehealth, Guttmacher Inst. (May 16, 2019), https://www.guttmacher.org/gpr/2019/05/improving-access-abortion-telehealth [https://perma.cc/QP8D-CL8B].
69 Id.
70 Id.
71 Rachel K. Jones & Elizabeth Witwer, Abortion Incidence and Service Availability in the United States, Guttmacher Inst. (2017), https://www.guttmacher.org/report/abortion-incidence-service-availability-us-2017 [https://perma.cc/6WPV-DS8V].
72 See Food & Drug Admin. v. Am. Coll. of Obstetricians & Gynecologists, 141 S. Ct. 578, 578 (2021).
73 Id.
74 Cappello, supra note 56.
75 Id.; Medication Abortion, supra note 2.
76 Facts are Important: Medication Abortion “Reversal” Is Not Supported by Science, Am. Coll. of Obstetricians & Gynecologists, https://www.acog.org/advocacy/facts-are-important/medication-abortion-reversal-is-not-supported-by-science#:~:text=Claims%20regarding%20abortion%20%E2%80%9Creversal%E2%80%9D%20treatment,to%20stop%20a%20medical%20abortion [https://perma.cc/6T2M-GKLE] (last visited Feb. 22, 2022).
77 Medication Abortion, supra note 2.
78 Id.
79 See, e.g., Am. Med. Ass’n v. Stenehjem, 412 F. Supp. 3d 1134, 1134 (D.N.D. 2019).
80 Id. at 1138.
81 Id. at 1150-51.
82 Covid Data Tracker, Ctrs. for Disease Control & Prevention, https://covid.cdc.gov/covid-data-tracker/#cases_casesinlast7days [https://perma.cc/4QNL-GETT] (last visited Feb. 17, 2022).
83 Id.
84 Joint Statement on Abortion Access During the COVID-19 Outbreak, Am. Coll. of Obstetricians & Gynecologists (Mar. 18, 2020), https://www.acog.org/news/news-releases/2020/03/joint-statement-on-abortion-access-during-the-covid-19-outbreak [https://perma.cc/S6NM-RCH9].
85 Id.
86 Id.
87 See Laurie Sobel et al., State Action to Limit Abortion Access During the COVID-19 Pandemic, Kaiser Fam. Found. (Aug. 10, 2020), https://www.kff.org/coronavirus-covid-19/issue-brief/state-action-to-limit-abortion-access-during-the-covid-19-pandemic/ [https://perma.cc/5WH9-3KRF].
88 Id.; see, e.g., Yashica Robinson et al. v. Marshall, 2:19cv365-MHT (WO) (M.D. Ala. 2020); South Wind Women’s Center v. Stitt; CIV-20-277-G (W.D. Okla. 2020).
89 Sobel et al., supra note 87.
90 Id.
91 Id. See also Joint Statement on Abortion Access During the COVID-19 Outbreak, supra note 84.
92 For example, in Alabama, the federal district court issued a preliminary injunction which allowed abortion providers to determine for each patient if an abortion was necessary to avoid additional risk, expense, or legal barriers and that injunction was upheld by the 11th Circuit Court of Appeals. In Tennessee, a federal district court blocked Tennessee’s order to suspend abortions and the 6th Circuit Court of Appeals affirmed the district court. See Sobel et al., supra note 87.
93 Medication Abortion, supra note 53.
94 See Sobel et al., supra note 87.
95 Id.
96 Expanding Telemedicine Can Ensure Abortion Access During COVID-19 Pandemic, supra note 12.
97 See Amrutha Ramaswamy, et al., Medication Abortion and Telemedicine: Innovations and Barriers During the COVID-19 Emergency, Kaiser Fam. Found. (June 8, 2020), https://www.kff.org/policy-watch/medication-abortion-telemedicine-innovations-and-barriers-during-the-covid-19-emergency/ [https://perma.cc/56BD-GNML].
98 Id.
99 Directive on Resuming Elective Procedures, Phase IV, Ark. Dep’t of Health (May 25, 2020), https://www.healthy.arkansas.gov/images/uploads/pdf/elective_surgery_phase_4.pdf [https://perma.cc/G7H9-QQ5U].
100 In re Abbott, 956 F.3d 696 (5th Cir. 2020), cert. granted, judgement vacated sub nom; Planned Parenthood v. Abbott, No. 20-305, 2021 WL 231539 (U.S. Jan. 25, 2021); see Keating et al., supra note 9.
101 Id.
102 In re Abbott, 956 F.3d at 703-14.
103 Jonathan Bearak et al., COVID-19 Abortion Bans Would Greatly Increase Driving Distances for Thor Seeking Care, Guttmacher Inst., https://www.guttmacher.org/article/2020/04/covid-19-abortion-bans-would-greatly-increase-driving-distances-those-seeking-care [https://perma.cc/D2W4-FGMD] (last visited Mar. 22, 2021).
104 Planned Parenthood, No. 20-305, 2021 WL 231539; see Sami Sparber, In Win for Planned Parenthood, U.S. Supreme Court Wipes Case Law Supporting Texas Pandemic Abortion Ban From the Books, Tex. Tribune (Jan. 25, 2021), https://www.texastribune.org/2021/01/25/supreme-court-texas-abortion-ban/ [https://perma.cc/ZKV9-F5LP].
105 Adam Liptak, Supreme Court Revives Abortion-Pill Restriction, N.Y. Times (Jan. 12, 2021), https://www.nytimes.com/2021/01/12/us/supreme-court-abortion-pill.html [https://perma.cc/DB6G-U5U9].
106 Id.
107 Food & Drug Admin. v. Am. Coll. of Obstetricians & Gynecologists, 141 S. Ct. 578, 578 (2021); Liptak, supra note 105.
108 Id.
109 Food & Drug Admin., 141 S. Ct. at 578.
110 Id. at 578.
111 Id. at 579.
112 Id.
113 Id. at 578.
114 Liptak, supra note 105.
115 Id.; Supreme Court Grants Trump Administration Request to Endanger Abortion Patients During the Pandemic, ACLU (Jan. 12, 2021), https://www.aclu.org/press-releases/supreme-court-grants-trump-administration-request-endanger-abortion-patients-during [https://perma.cc/5JMW-LSCJ].
116 Id.
117 Letter from Carolyn B. Maloney, Chairwomen, Comm. on Oversight & Reform, to Janet Woodcock, Comm’r., U.S. Food & Drug Admin. (Feb. 9, 2021), https://oversight.house.gov/sites/democrats.oversight.house.gov/files/2021-02-09.CBM%20Pressley%20et%20al.%2C%20to%20Woodcock-FDA%20re%20Mifepristone%20REMS.pdf [https://perma.cc/K5H9-44BU].
118 Id.
119 Letter from Ted Cruz et al., U.S. Senator, to Stephen Hahn, Comm’r., U.S. Food & Drug Admin. (Sept. 1. 2020), https://www.cruz.senate.gov/files/documents/Letters/2020.09.01%20--%20Pro-Life%20Mifeprex%20Letter%20to%20FDA%20-%20FSV.pdf [https://perma.cc/KB9J-PE5Y].
120 Id.
121 U.S. Food & Drug Admin., supra note 23.
122 Id.
123 Ramaswamy et al., supra note 97.
124 Id.
125 Id.
126 Id.
127 Id.
128 Id.
129 Id.
130 Medication Abortion, supra note 2.
131 Id.
132 Id.
133 Id.
134 Id.
135 Id.
136 Id.
137 Donovan, supra note 68.
138 Id.
139 Id.
140 Id.
141 Id.
142 Id.
143 Id.
144 Medication Abortion, supra note 2.
145 Id.
146 Expanding Telemedicine Can Ensure Abortion Access During COVID-19 Pandemic, supra note 12.
148 Medication Abortion, supra note 2.
149 Id.
150 Donovan, supra note 68.
151 Expanding Telemedicine Can Ensure Abortion Access During COVID-19 Pandemic, supra note 12.
152 Ramaswamy et al., supra note 97.
153 Medication Abortion, supra note 2.
154 Id.
155 Id.; State Facts About Abortion: Missouri, Guttmacher Inst., https://www.guttmacher.org/fact-sheet/state-facts-about-abortion-missouri [https://perma.cc/EN7C-QVH3] (last visited Mar. 22, 2021).
156 Medication Abortion, supra note 2.
157 Sobel et al., supra note 87.
158 Facts are Important: Medication Abortion “Reversal” Is Not Supported by Science, supra note 76.
159 See Brief of Abortion Care Network et al. as Amici Curiae in Support of Respondents at 32, Dobbs v. Jackson Women’s Health Org., 141 S. Ct. 2619 (2021) (No. 19-1392); Brief of Leading Medical Organizations as Amici Curiae in Support of Petitioners at 16, Whole Woman’s Health v. Jackson, 142 S. Ct. 522 (2021) (No. 21-46).
160 See U.S. Food & Drug Admin., supra note 23.
161 See Supreme Court Grants Trump Administration Request to Endanger Abortion Patients During the Pandemic, supra note 115.
162 Id.
163 Id.
165 Women’s Health Protection Act, H.R. 3755, 117th Cong. (2021); Summary: H.R.3755 – 117th Congress (2021-2022), Congress.gov, https://www.congress.gov/bill/117th-congress/house-bill/3755?s=1&r=70 [https://perma.cc/Q76W-CWBC] (last visited Feb. 22, 2022).
166 Id.
168 Id.
169 Id.
170 Id.
171 Id.
172 Id.
173 Donovan, supra note 68.
174 Id.
175 Ramaswamy et al., supra note 97.
176 Id.
177 Id.
178 Id.
179 Id.
180 Donovan, supra note 68.
181 See id.
182 Id.
183 Id.
184 See Supreme Court Grants Trump Administration Request to Endanger Abortion Patients During the Pandemic, supra note 115.
185 Donovan, supra note 68.
186 Id.
187 Id.
188 Id.
189 Id.
190 Id.
191 See id.
192 State Funding of Abortion Under Medicaid, Guttmacher Inst. (Dec. 1, 2020), https://www.guttmacher.org/state-policy/explore/state-funding-abortion-under-medicaid [https://perma.cc/43DA-NMG5].
193 Jessica Mason Pieklo, The Hyde Amendment and Beyond: The Conservative Attack on Reproductive Health Care That Just Won’t Quit, Rewire News Grp. (Sept. 30, 2015), https://rewirenewsgroup.com/article/2015/09/30/hyde-amendment-beyond-conservative-attack-reproductive-health-care-just-wont-quit/ [https://perma.cc/DL6C-YPAN].
194 See Memorandum from Joseph R. Biden Jr. on Protecting Women’s Health at Home & Abroad to the Sec’y of State, the Sec’y of Def., the Sec’y of Health & Human Servs., and the Adm’r of the U.S. Agency for Int’l Dev. (Jan. 28, 2021), https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/memorandum-on-protecting-womens-health-at-home-and-abroad/ [https://perma.cc/6CKV-NDPD].
195 Id.
196 See Donovan, supra note 68.
197 António Guterres, “Now is the Time for Unity”, United Nations (2020), https://www.un.org/en/un-coronavirus-communications-team/%E2%80%9Cnow-time-unity%E2%80%9D [https://perma.cc/EPW5-T3TV].
198 Ed Yong, America Should Prepare for a Double Pandemic, Atlantic (July 15, 2020), https://www.theatlantic.com/health/archive/2020/07/double-pandemic-covid-flu/614152/ [https://perma.cc/9645-CLUH].
199 See Rebouché, supra note 10.
200 Id.
201 Expanding Telemedicine Can Ensure Abortion Access During COVID-19 Pandemic, supra note 12.
202 Joint Statement on Abortion Access During the COVID-19 Outbreak, supra note 84.
203 Sobel et al., supra note 87.
204 Rebouché, supra note 10.
205 Id.
206 See id.
207 See id.
208 See Lydia Courtré, Hospitals take an ‘all-hands-on-deck’ approach to staffing during the pandemic, Mod. Healthcare (Apr. 13, 2020), https://www.modernhealthcare.com/hospitals/hospitals-take-all-hands-deck-approach-staffing-during-pandemic [https://perma.cc/24CB-SESB].
209 Medication Abortion, supra note 53.
210 See Medication Abortion, supra note 2.
211 See Sobel et al., supra note 87.
212 See K.K. Rebecca Lai & Jugal K. Patel, For Millions of American Women, Abortion Access Is Out of Reach, N.Y. Times (May 31, 2019), https://www.nytimes.com/interactive/2019/05/31/us/abortion-clinics-map.html [https://perma.cc/XV85-26FH]; Medication Abortion, supra note 2.
213 Medication Abortion, supra note 53.
215 Expanding Telemedicine Can Ensure Abortion Access During COVID-19 Pandemic, supra note 12.
216 See Rebouché, supra note 10.
217 Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292, 2296 (2016); Planned Parenthood of Southeastern Pennsylvania. v. Casey, 505 U.S. 833, 877-78 (1992).
218 Rebouché, supra note 10.
219 Id.
220 Id.
221 See Iryna Kyzyma, Rural-urban disparity in poverty persistence 13 (Univ. Wis.-Madison Inst. for Rsch. on Poverty ed., 2018); Bearak et al., supra note 103.
222 Both Justices Scalia and Rehnquist argued for a rational basis approach in Casey. Justice Thomas wrote in his part concurrence, part dissent that, “applying the rational basis test, I would uphold the Pennsylvania statute in its entirety” and “[w]e should get out of this area, where we have no right to be, and where we do neither ourselves nor the country any good by remaining.” Casey, 505 U.S. at 981, 1002. Justice Rehnquist wrote in his part concurrence, part dissent that, “[s]tates may regulate abortion procedures in ways rationally related to a legitimate state interest” and cited Williamson v. Lee Optical of Oklahoma, Inc., 348 U.S. 483, 491. Casey, 505 U.S. at 941. Conservative Supreme Court justices have pushed for this result for decades and accomplished their goal when they overturned Roe and removed the undue burden standard.
223 Medication Abortion, supra note 53.
224 Id.
225 Id.
226 See Sobel et al., supra note 87.
227 Medication Abortion, supra note 2.
229 See Sobel et al., supra note 87.