People forced to seek abortion medication outside the US as conservatives push for bans

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'The same amount of people still need abortions as they did before they started all these bans,' Amy Hagstrom Miller of Whole Woman's Health said.

Right-wing legislators continue to push abortion bans early in pregnancy after the U.S. Supreme Court in January refused to enjoin or overturn S.B. 8, Texas' six-week abortion ban. 

Concurrently, conservatives are also putting forward legislation seeking to ban or highly restrict access to medication abortion.

With this, people are beginning to look to providers outside the United States to access abortion pills. 

Abortion access has plummeted in Texas after the state passed a ban on the procedure at six weeks that includes an enforcement mechanism allowing anyone anywhere to sue someone who "aids or abets" another person in obtaining after the prescribed time period.

In August 2021, there were over 5,400 abortions in the state, but that number dropped to 2,200, a decrease of 60%, in September 2021.

Although Texas has said it will release more statewide data monthly, as of early February 2022, only the September 2021 numbers were available

At the same time that Texas made in-person abortion nearly impossible to access, the state also moved to cut off access to medication abortion pills. A law passed in December 2021 makes it a criminal offense resulting in possible fines of up to $10,000 and the threat of jail time for anyone who prescribes medication abortion pills remotely, through the mail or via telemedicine. 

Even though Texas is attacking abortion access on all fronts, people in the state still need abortions. Seven surrounding states have seen a huge uptick in the number of Texans — an average of 1,400 per month — obtaining abortions in at least 34 clinics outside of the state.

Other people appear to be turning to providers outside of the United States for medication abortion pills. Aid Access, an international nonprofit that assists people in obtaining medication abortions, saw requests from Texas jump from a daily average of 10.8 per day to 137.7 per day immediately after S.B. 8 passed. 

Aid Access, along with similar groups, such as Plan C Pills, use non-U.S. prescribers and providers to get abortion pills to people in states that have blocked access to medication abortion. This could become more widespread as more states pass restrictive abortion bans, some of which include restrictions on telehealth prescribing and mailing of abortion pills. 

For example, on Jan. 1 of this year, Alabama began barring the use of telehealth for medication abortions, forcing people who are unable to travel to a clinic for the pills to seek a source outside the state. South Dakota is also pushing for an in-person requirement for people to obtain the pills. In South Dakota, that's especially problematic because the state has only one abortion provider, a Planned Parenthood clinic in Sioux Falls. A person living across the state from that city would have to drive for nearly five hours one way just to obtain a prescription for the medication. 

Access to abortion is about to decrease in other places as well. Florida just banned all abortions after 15 weeks, and Idaho looks set to pass a six-week ban soon. If Texas is any guide, that will lead to a sharp decrease in abortions in those states, but an increase in the number of people obtaining the procedure outside of those states.

However, accessing abortion pills via non-U.S. providers is not necessarily without legal risk. Plan C Pills has a section on its website that details a possible issue, which is that a person could be prosecuted for obtaining abortion pills in a state where those pills are restricted. But it says the risk of prosecution is rare: Plan C Pills notes that in the last 20 years, 24 people have been prosecuted for self-managing abortions during a period in which around 100,000 people have self-managed abortions. 

The website Repro Legal Healthline also provides information on possible legal risks. At this point, the site notes that it isn't aware of any case in which a person was arrested or investigated solely for ordering abortion pills online. That said, it states that there are at least four cases in which a person who ordered abortion pills online was later criminally charged for self-managing their abortion, and the fact that they had ordered medication abortion pills online was used against them

The necessity of accessing abortion pills from prescribers and pharmacies outside the United States will likely only continue to increase as states continue to pass bans and tighten access to medication abortion. The number of self-managed abortions will likely continue to rise, as will the number of people seeking abortions in states that are preserving access.

As Amy Hagstrom Miller, the founder, president, and CEO of the abortion provider Whole Woman's Health, put it, "The same amount of people still need abortions as they did before they started all these bans."

Published with permission of The American Independent Foundation.