Abortion Pills Will Be the Next Battleground in a Post-Roe America

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Medication abortion became legal in the United States in 2000, when mifepristone was approved by the F.D.A. The agency imposed tight restrictions on the drug, many of which remain in place. But access to the method increased in 2016, when the F.D.A. expanded the time frame within which the drug could be taken — from seven weeks to 10 weeks into a pregnancy.

As conservative states began passing more laws restricting access to surgical abortions, more patients opted for pills, especially because they can be taken in the privacy of one’s home.

The Covid pandemic fueled that trend. The Guttmacher Institute, a research organization that supports abortion rights, reported that in 2020, medication abortion accounted for 54 percent of all abortions.

Early in the pandemic, medical groups filed a lawsuit asking the F.D.A. to lift its requirement that mifepristone, which blocks a hormone crucial to the continuation of a pregnancy, be dispensed to patients in person at a clinic or doctor’s office. Citing years of data showing that medication abortion is safe, the medical groups said that patients faced a greater risk of being infected with the coronavirus if they had to visit clinics to obtain mifepristone.

For portions of the pandemic, the F.D.A. temporarily lifted the in-person requirement, then permanently removed it in December. In addition, the agency said pharmacies could begin dispensing mifepristone if they met certain qualifications. The agency is in the process of hammering out those qualifications with the two manufacturers of the drug, and reproductive health organizations said that some national retail pharmacy chains have expressed interest in being able to dispense the medication in some states, at least by mail.

The second medication, misoprostol, which causes contractions similar to those of a miscarriage and is taken up to 48 hours later, has long been available for a variety of uses with a typical prescription.

Understand the State of Roe v. Wade

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What is Roe v. Wade? Roe v. Wade is a landmark Supreme court decision that legalized abortion across the United States. The 7-2 ruling was announced on Jan. 22, 1973. Justice Harry A. Blackmun, a modest Midwestern Republican and a defender of the right to abortion, wrote the majority opinion.

What was the case about? The ruling struck down laws in many states that had barred abortion, declaring that they could not ban the procedure before the point at which a fetus can survive outside the womb. That point, known as fetal viability, was around 28 weeks when Roe was decided. Today, most experts estimate it to be about 23 or 24 weeks.

What else did the case do? Roe v. Wade created a framework to govern abortion regulation based on the trimesters of pregnancy. In the first trimester, it allowed almost no regulations. In the second, it allowed regulations to protect women’s health. In the third, it allowed states to ban abortions so long as exceptions were made to protect the life and health of the mother. In 1992, the court tossed that framework, while affirming Roe’s essential holding.

What would happen if Roe were overturned? Individual states would be able to decide whether and when abortions would be legal. The practice would likely be banned or restricted heavily in about half of them, but many would continue to allow it. Thirteen states have so-called trigger laws, which would immediately make abortion illegal if Roe were overturned.

A senior Biden administration official said this week that officials are looking for further steps the administration can take to increase access to all types of abortion, including the pill method. The official, speaking on the condition of anonymity to discuss the leaked Supreme Court decision, said that President Biden directed his team “at every aspect in every creative way, every aspect of federal law, to try to do all that’s possible” to protect abortion rights.