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How to get an abortion in post-Roe America

If the right to abortion is overturned, women will be forced to seek ingenious means to terminate an unwanted pregnancy.

By Charlotte Kilpatrick

On Monday 2 May, Politico published a leaked draft opinion indicating that the US Supreme Court is poised to overturn its landmark 1973 Roe vs Wade decision guaranteeing women the right to seek an abortion – and the 1992 decision Planned Parenthood vs Casey which largely protected that right.

Although the number of abortions taking place is falling, it still remains a common procedure in the US with nearly one in four women obtaining a termination by the age of 45. The majority of abortions (54 per cent) in the US are medical, rather than surgical, whereby women take two pills approved by the US Food and Drug Administration (FDA). These pills can be taken safely up to 70 days after a women’s last menstrual period.

The Supreme Court’s final opinion is not expected for another month and could change before publication. The draft, written by the conservative judge Samuel Alito, says that the issue of abortion should be returned to the states and the people’s elected representatives.

“Trigger laws”, which would automatically outlaw abortion if Roe is overturned, have been passed in 22 states. A number of other states would be likely to follow suit. If the draft opinion does not substantively change, it will mean that women in those states will automatically face restricted access to abortion that will set the legal clock back to the pre-Roe days.

The silver lining is that abortion pills are becoming easier to obtain in all 50 states.

[See also: Goodbye, Roe v Wade?]

In December the Biden administration permanently lifted a restriction that required in-person appointments for mifepristone, one of the two abortion pills. The decision allows women who wish to terminate a pregnancy to have a telemedicine appointment with a medical provider who can prescribe the pills and send them by mail to the patient.

Lawmakers in conservative states have reacted quickly to the decision to allow telemedicine appointments. Nineteen states have banned or restricted the use of telehealth for abortions, including Texas, where nearly all abortions are banned after six weeks. Yet despite the ban, Texan women have managed to order the abortion pills online from international non-profit organisations and online pharmacies. A study from the Journal of the American Medical Association said orders for the drugs from the international non-profit Aid Access increased 1,180 per cent the first week after the Texas law went into effect.

Aid Access provides online consultations to get the abortion pill by mail. In states including California, Idaho, New York and Virginia, the charity’s American doctors provide the pills by post within a few days. In the other US states, European doctors administer the prescriptions, and the pills are mailed from a trustworthy pharmacy in India. Aid Access says it can mail pills to states that have restrictive abortion laws because it is located outside the US and obstructing mail is a federal crime. The catch is that delivery can take three to four weeks.

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There are ways around waiting three to four weeks for the abortion pill. Women living in states such as Texas have crossed state lines to have their telemedicine appointment in their cars and had pills delivered to a friend’s address in a neighbouring state. Women also don’t need to be pregnant before ordering the pills. The shelf life for misoprostol is three years, and for mifepristone it is 18 months. A woman who is worried about maintaining autonomy over her body could order the pills in advance and keep them safely in a bathroom cupboard in case they are ever needed. An Aid Access consultation, including the pills, costs $150 (£119) with a US doctor and $110 for one with a European doctor.

On the Plan C Campaign website women in different states can find information on ways to get an abortion. A scroll-down menu allows users to pick their state and then directs them to ways to obtain the pills. For Alabama, a very restrictive state, the website suggests five online pharmacies, telemedicine with Aid Access, three directories for in-person clinics and three creative ways to access pills, including creating a “virtual mailbox” in California.

For now, these measures exist in a grey area. If Roe is overturned, opponents of abortion will almost certainly test their legality in the courts. One such measure includes proposed travel bans that would make it illegal to cross state borders for an abortion.

Charities also exist that help women to fund abortions and travel to clinics. The National Network of Abortion Funds allows users to navigate available funding options by state and clinic. Those concerned that women may soon face restricted access to abortion can donate to the network or to Planned Parenthood US. The latter allows individuals to donate in honour of the memory of someone special, including Justice Alito.

[See also: The Texas abortion law is a threat to women everywhere]

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