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Remote Access to Abortion Medication Restricted by Supreme Court

The court reinstated in-person requirements despite the ongoing threat of COVID. Reproductive justice activists in New York are responding with an educational campaign.

A Supreme Court decision reinstates a requirement for patients to pick up the abortion drug mifepristone in person. The drug has been approved for use in the US for 20 years.
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On Tuesday, January 12, the Supreme Court made its first ruling on an abortion case since Amy Coney Barrett, a vocal abortion opponent, joined the bench. The decision, in Food and Drug Administration v. American College of Obstetricians and Gynecologists, reinstates a requirement that patients seeking abortion medication must pick it up in person, rather than receive it through the mail after consulting a healthcare provider via teleconference.

In states like New York, the in-person requirement was suspended at the start of the ongoing COVID-19 pandemic due to the risk of contagion. With its untimely reinstatement, local advocates for reproductive justice now fear that New Yorkers, including those in the Hudson Valley who were previously underserved by abortion providers, will further lose access.

“This order by the Supreme Court creates an undue hardship on many people in the mid-Hudson Valley by forcing them to travel miles to pick up the abortion pill in-person, at a health center,” says Lori Trzop, vice president of healthcare operations for Planned Parenthood of Greater New York. “A person’s zip code should not determine whether or not they can access safe, legal abortion care.”

Food and Drug Administration v. American College of Obstetricians and Gynecologists concerns the distribution of mifepristone and misoprostol, two drugs colloquially known as “abortion pills.” Taken one after the other, with one or two days in between, the pills induce what’s known as a medical abortion (as opposed to a surgical abortion). Medical abortions are routine: The latest statistics from the Centers for Disease Control and Prevention indicate that they made up more than 38 percent of all legal abortions in the United States in 2018. Misoprostol and mifepristone are both safe and effective enough to be the standards offered by Planned Parenthood up to 11 weeks into pregnancy. In some parts of the world, like Latin America, they are even available directly from pharmacies, and the World Health Organization includes them on its list of essential medicines.

Despite this, the FDA places what critics describe as politically motivated restrictions on access to the pills, requiring that they be picked up in person—even if patients have previously consulted with a healthcare provider.

“Abortion is time-sensitive, essential health care,” says Trzop. “Forcing patients to unnecessarily travel to a health center to access safe medication abortion puts them at greater risk of COVID-19 exposure.”

Following the onset of the pandemic in the United States, the American College of Obstetricians and Gynecologists challenged the FDA restrictions on the abortion pills in federal court, winning a nationwide suspension in July. In states like New York, where local legislation permits telemedicine, or the remote delivery of medical services via teleconference technologies, the suspension meant that patients could receive the pills without having to visit a healthcare provider in person. But the FDA under former commissioner Stephen Hahn, appointed by Donald Trump, challenged the suspension in August, bringing the matter to the Supreme Court. The court’s ruling in January essentially turns the clock back to before COVID—while COVID continues.

“Even during a pandemic, the Supreme Court, which now includes three Trump-appointed justices, allowed another egregious barrier to advancing healthcare equity,” says Trzop of the ruling. She expresses hope that the new presidential administration of Joe Biden, including current FDA commissioner Janet Woodcock, will reconsider the agency’s insistence on in-person requirements.

“We’re encouraged by the Biden-Harris administration’s actions to undo the heinous policies of the past four years,” she says, “and confident that New York will continue to work toward a future where sexual and reproductive health care, including abortion, is accessible to all.”

The Response in the Hudson Valley

Other reproductive justice advocates are not waiting for the Biden administration to act. In the Hudson Valley, some are responding with an educational campaign aimed at underserved areas—advocating not only for greater access through better policy, but by any means necessary.

In the mid-Hudson Valley, there are currently only two Planned Parenthoods in operation: in Newburgh and Poughkeepsie. Two other locations, in Goshen and Kingston, have temporarily closed due to the pandemic. Another location, in New Paltz, had closed previously, only to have an anti-abortion “crisis pregnancy center,” the Bravo Center, open in its place. Without access to abortion pills via telemedicine, advocates fear that Hudson Valley residents, especially those in rural areas or those without access to transportation, such as students, have effectively lost access to legal abortions altogether.

“It can be challenging to obtain an abortion in the Hudson Valley,” says Kate Krimsky, a local reproductive justice advocate. “Many local healthcare providers have limited capacity due to layoffs and COVID-19, and fake clinics—crisis pregnancy centers—are cropping up in our most vulnerable communities to further limit access to care. The ability to receive medication by mail was a godsend to those who needed it most.”

In response to the recent Supreme Court decision, advocates like Krimsky are trying to spread greater awareness of “self-managed abortions.” In essence, a medical abortion becomes a self-managed abortion when the patient procures and administers abortion pills themselves, rather than relying on healthcare professionals.

“When you get the flu, sometimes you go to the doctor, sometimes you deal with it yourself at home,” says Susan Yanow, a reproductive health consultant with Self-Managed Abortion, Safe and Supported. “In the abortion world, with the pill, it’s the same.”

Yanow helped launch SASS’s in 2017. The website not only provides users with access to basic information about the abortion pills, such as how they can be taken safely, but connects them with counselors who can assist on a case-by-case basis. The hope is that making this knowledge more widely available will restore a degree of autonomy to people who live far from abortion clinics or who are constrained by anti-abortion restrictions, such as the recent Supreme Court decision. Yanow explains that, because it is illegal to direct anyone to underground sources for the pills, is forced to rely on newspaper reports of how others procured them and limits the information that it collects about users.

“In the Hudson Valley, there are many people who are far from a provider,” says Yanow. “SASS does not collect anything but state data, and there are a lot of references from New York.”

To help spread awareness about self-managed abortions, as well as as a resource, SASS organizes informational trainings and distributes educational material, such as stickers and flyers. Krimsky attended one of these trainings in 2019 and, in response to the recent Supreme Court decision, has begun distributing stickers advertising the website. She acknowledges that advocates like herself have been bracing for anti-abortion rulings from the court for some time now.

“With the current makeup of the Supreme Court, many activists have been preparing for a post-Roe world,” says Krimsky, referring to Roe v. Wade, the Supreme Court decision legalizing abortion in 1973. “People in our area are stockpiling the Plan B pill and supporting organizations like SASS. We’re attending workshops to learn how people seeking abortions around the world are safely using medicine to self-manage their own abortions at home.

“This medicine is safely used by millions of people around the world to manage their own healthcare,” she says of abortion pills. “Once we know how to access and use this medicine, hostile legislation cannot govern us. We control our bodies.”