The Right-Wing War on Medication Abortion

In 2000, Mifepristone, a medication that induces abortion when taken in the first nine weeks of pregnancy, was approved in the United States as a new way to terminate a pregnancy without the need for an abortion-clinic visit or an invasive internal procedure. Abortion-rights activists couldn’t wait to see access to Mifepristone expand across the country. They believed it would free abortion from the confines of a clinic landscape that by 2000 was already faltering and beginning to implode, and allow any general practitioner to be able to offer it to a patient.

But the right-wing opposition—the very force that kept Mifepristone out of the U.S. for more than a decade before the FDA approved it and a company manufactured and distributed it—blocked that dream before it could ever be a reality. They pressured the FDA into keeping the medicine on a Risk Evaluation and Mitigations Strategies (REMS) designation, making most doctors unable or unwilling to take the additional steps needed to prescribe the drugs. They introduced model legislation that forced clinics—the only ones who would prescribed the medication—to follow labeling recommendations rather than their own developed medical best practices, mandated face-to-face meetings over and over again with medical providers, and blocked any possibilities of using telemedicine for the process, either through bills, funding attack, or pressure from state boards of health. What could have been a breakthrough in early abortion availability became just another disappointing bureaucratic nightmare for the areas of the country that need most needed more providers, all because abortion opponents were always planning one step ahead.

Now, we may be watching the very same thing happen all over again.

Roe v. Wade is clearly in jeopardy, with the newly far-right Supreme Court of the United States poised to reverse the original 1973 decision sometime within the next two years. Even if the ruling does stay in place, it is just as likely that it will be eroded to the point where at least a dozen states will have no access to legal abortion in a clinic setting due to restrictions or the closure of all of the clinics within that state.

The state of abortion access is already in dire straits for many people in the U.S., especially the poor and people of color, and particularly people who live in rural communities. About 90 percent of counties in America have no abortion provider, and almost 14 percent of Americans are living below the poverty level. Accessing abortion at a clinic is impossible for many, due to financial barriers, physical barriers, or both. Online medication abortion outlets—usually located outside the United States and often far cheaper and much more convenient from a logistical standpoint than an in-clinic abortion paid out of pocket—has become the alternative for those who in many cases have no other options.

Abortion opponents know it, and are aware it will be the biggest refuge of those who live in states that have few to no clinics remaining. And now, they are signaling how they will be closing the loophole that, until recently, the government had been turning a blind eye to.

Ordering medication from the internet is a commonplace occurrence that escalates especially as U.S. prescription drug costs skyrocket and the “affordability” of the Affordable Care Act dwindles due to GOP sabotage. According to Kaiser Health News, the number of people reporting that they imported drugs via either online pharmacies or other means from across international borders was as much as 8 percent in 2016, up 6 percent in just five years. It’s an importing issue that the government mostly ignores. While they warn about the consequences of purchasing possibly substandard drugs from unknown companies, there have been few seizures of medicines or indictments of those buying medication for their own use.

That’s changing where abortion-inducing drugs are concerned. We saw the first blow against medication abortion obtained outside the clinic setting in 2018, when a New York woman named Ursula Wing was targeted for providing medicine to people who contacted her through a blog post she wrote about her own experience inducing an abortion using drugs off the internet.  Wing sent medicine to individuals for most of two years before she was raided by FDA agents, who sprung into action after a man was arrested for using the medication he procured from her to allegedly attempt to induce a girlfriend’s abortion against her will.

That Wing was providing medication wasn’t necessarily a secret. Although she wasn’t exactly publicizing her business, it was well known enough to have made it onto the Plan C report card, which listed it as the best place to obtain medication abortions due to the reliability, low cost, and quick turnaround. It was the fact that they were obtained by someone who used them to allegedly perform a forced abortion that appears to have been the catalyst for the government action.

That was the first blow. The second came in March 2019, when the website Aid Access was served with a letter from the FDA telling it that it too must stop offering medication-abortion kits to pregnant people in the United States. Like Wing, Aid Access had been providing this service in a sort of legal gray zone—in this case setting up a website to offer drugs to those who registered and provided medical information that suggested that they were good candidates for the medication-abortion procedure.

Aid Access, which is run by European activist Rebecca Gomperts of Women on Web and Women on Waves, two other organizations that offer pills to those who live in countries where abortion is illegal, provided medications on the down low in spring 2018 but did not announce their services publicly until October. Once they did, abortion opponents immediately urged the FDA to investigate, and in March, the FDA told Gomperts to shut it down. Only in May did Gomperts reverse her decision, saying she would fight the Trump administration over what she sees as a politically motivated action against her website.

The FDA crackdown on Aid Access shows exactly how the current administration is likely to target online providers in order to stop them from offering services. Abortion opponents claim Gomperts medications are “knock-off drugs” and bemoan their lack of FDA warning labels, but ignore that it is, in fact, the same medicine, just under a different brand name, because there is only one medication abortion manufacturer in the U.S. But even when presented with medication abortion that is the exact version approved by the FDA, the Right has just as many issues, attacking current medication-abortion programs by mail, too.

One apparent concern anti-abortion activists have is that Planned Parenthood—which is doing a pilot medication-abortion-by-mail program—would eventually offer medicines in all 50 states even if abortion is banned within some of them, allegedly assuming that the organization would break the law in order to ensure pregnant people receive care. Their proposed solution to this non-existent medical threat?

A federal ban on abortion pills through the mail.

“This is a sneaky backdoor way of ensuring that babies continue to die and abortionists continue to line their pockets. It makes any Supreme Court decision that may overturn Roe almost irrelevant,” said Operation Rescue president Troy Newman in an article depicting the current abortion-by-mail options. “Now that we know their backup plan if Roe v. Wade is overturned, our backup plan needs to contain federal legislation that will prohibit the dangerous dispensing of abortion drugs through the mail.”

Newman wants a full federal ban on medication abortion by mail. It’s unlikely that could happen, but even without a ban he has set up a potential argument for the federal government to seize any mail by Planned Parenthood or any other entity that could potentially offer medication abortion, claiming they are checking for illegal drugs. That could impact other by-mail programs, such as birth control by mail, crippling the health-care provider in the process.

The truth is, the Right can find reasons to justify looking through the mail for possible illegal abortion drugs. Packages from India, Russia, and other countries known for sending medicines could then be checked as a “precaution.” Mailers from known reproductive-health-care providers will be scrutinized, with an excuse that the government is simply checking for medication-abortion kits heading into states with abortion bans.

Then, there is the very bold claim being floated by abortion opponents: that medication abortion is being purchased by human traffickers attempting to cover up their crimes. When the anti-abortion group Americans United for Life (AUL) held a human-trafficking panel in May, Chuck Donovan of Charlotte Lozier Institute (a right-wing version of the Guttmacher Institute) claimed that human traffickers were purchasing bulk orders of medication abortion, without providing any evidence to back up his statement. “Where do bulk orders from online chemical abortion providers go? Likely to human traffickers. 1 woman doesn’t need a bulk order of Mifeprex,” Donovan said, according to AUL’s Twitter feed. “This isn’t about choice—this is about control & traffickers limiting women’s freedom.”

Legal abortion is about to disappear, and abortion opponents have prepared their talking points for why abortion pills by mail need to be ended, and how they intend to justify their assault on the mail to ensure it occurs. It’s a process that has even the more libertarian side of the right—those who still value civil liberties—worried about the fallout from these acts. Elizabeth Nolan Brown at Reason envisions a world where websites and apps that mention where to get medicines—or even just how to take them—could be shut down under the Communications of Decency Act, or where the Mann Act may be used to hunt for people assisting abortion-seeking patients in finding legal care in other states, or illegal care in their homes. It’s just a small step from going back to enforcing the Comstock Act, which made it illegal to publish “indecent” content like ads for contraception back in the 1800s, and it’s one that doesn’t seem that out of reach for today’s far-right administration.

With that in mind, we need to act like the Right. While they are brainstorming how to dismantle the ability to order abortion medications online, we need to prepare our plans for how we intend to continue making it available and accessible. Despite the growing number of restrictions, medication-abortion options are spreading. One telemed test program offers medicines as long as they are sent to the state where a provider is licensed—expanding options for those who are in anti-telemed states who may be able to more easily get the drugs somewhere close by. For ordering from online pharmacies outside the U.S., legal dangers can be mitigated by taking safeguards like using private browsers, not talking about the process on unsecured phone lines or sending emails from personal email addresses, or texting only with encrypted apps like Signal. The risk remains, obviously, but since anti-abortion activists say they are only seeking out drug providers, not patients, that risk may be less for those purchasing than those selling.

And, at some point, there may very well need to be a public tipping point when it comes to making medication abortion public and accessible in an act of civil disobedience. “I want some copycats,” Ursula Wing told Mother Jones after the FDA raid of her apartment. “There’s not enough people doing this.”

How many copycats would it take to make the government throw its hands in the air and give up? That’s a question abortion-rights activists may be forced to find the answer to very, very soon.