Next battle over access to abortion will focus on pills

SIOUX FALLS, S.D. — It took two trips over state lines, navigating icy roads and a patchwork of state laws, for a 32-year-old South Dakota woman to get abortion pills last year.

For abortion-seekers like her, such journeys, along with pills sent through the mail, will grow in importance if the Supreme Court follows through with its leaked draft opinion that would overturn the landmark Roe v. Wade decision and allow individual states to ban the procedure. The woman, who spoke on the condition of anonymity because she was concerned for her family’s safety, said the abortion pills allowed her to end an unexpected and high-risk pregnancy and remain devoted to her two children.

But anti-abortion activists and politicians say those cross-border trips, remote doctors’ consultations and pill deliveries are what they will try to stop next.

“Medication abortion will be where access to abortion is decided,” said Mary Ziegler, a professor at Florida State University College of Law who specializes in reproductive rights. “That’s going to be the battleground that decides how enforceable abortion bans are.”

Use of abortion pills has been rising in the U.S. since 2000 when the Food and Drug Administration approved mifepristone — the main drug used in medication abortions. More than half of U.S. abortions are now done with pills, rather than surgery, according to the Guttmacher Institute, a research group that supports abortion rights.

Two drugs are required. The first, mifepristone, blocks a hormone needed to maintain a pregnancy. A second drug, misoprostol, taken one to two days later, empties the uterus. Both drugs are available as generics and are also used to treat other conditions.

The FDA last year lifted a long-standing requirement that women pick up abortion pills in person. Federal regulations now also allow mail delivery nationwide. Even so, 19 states have passed laws requiring a medical clinician to be physically present when abortion pills are administered to a patient.

South Dakota is among them, joining several states, including Texas, Kentucky, Arkansas, Ohio, Tennessee and Oklahoma, where Republicans have moved to further restrict access to abortion pills in recent months.