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Several states are proposing new restrictions on abortion pills


As access to abortion in medical facilities becomes more limited across parts of the country, many patients are turning to abortion pills. As NPR's Sarah McCammon reports, conservative state lawmakers are taking notice.

SARAH MCCAMMON, BYLINE: For most of the almost 50 years since the Roe v. Wade Supreme Court decision legalized abortion nationwide, clinics have been the focus of the battle over abortion rights. Protesters gather outside on sidewalks. And Republican state lawmakers try to regulate what happens inside through laws restricting which health care providers can perform abortions, the kind of counseling required and which procedures are allowed. But now more than half of abortions are taking place with pills.

RACHEL K JONES: For a lot of people, having the option of having an abortion in the privacy and comfort of their own home is appealing.

MCCAMMON: Rachel K. Jones is a research scientist with the Guttmacher Institute, which supports abortion rights. According to data released by Guttmacher earlier this year, abortion pills, not surgical procedures, accounted for 54% of abortions in 2020. That makes medication abortion the dominant choice in the United States for the first time since the Food and Drug Administration approved an abortion pill more than 20 years ago.

JONES: In some states, the pills can be mailed to people. So they don't have to travel to the clinic to get the medication.

MCCAMMON: During the pandemic, the FDA relaxed rules requiring the drugs to be dispensed in person, making it easier for patients to get a medication abortion through telehealth. The Biden administration recently made those changes permanent. And now Republican lawmakers in several states are pushing back. In South Dakota, Governor Kristi Noem recently signed legislation designed to restrict access to the drugs. Planned Parenthood says similar restrictions have been introduced in two dozen states this year, some of which would ban the pills altogether if Roe v. Wade is overturned. In Georgia, Republican State Senator Bruce Thompson sponsored a bill banning abortion pill delivery by mail and requiring doctors to examine patients in person before prescribing them.


BRUCE THOMPSON: SB 456 seeks to protect the cherished doctor-patient relationship.

MCCAMMON: That position is at odds with that of major medical groups, including the American College of Obstetricians and Gynecologists and the American Medical Association, who have long supported easing access to the pills and called for lifting the in-person dispensing requirement. Thompson opposes abortion rights. But he claims this bill is all about patient safety.


THOMPSON: Why would we not do everything within our power to protect women's health and safety during this difficult time in their lives?

MCCAMMON: But opponents say the bill could make patients less safe. During floor debate, several lawmakers noted that Georgia is among the states with the highest rates of maternal mortality, and that those death rates are dramatically higher for Black women. State Senator Kim Jackson, a Democrat, noted that many people, particularly in rural areas, lack access to pregnancy care.


KIM JACKSON: And what's really cruel about this bill is that those who are already the most vulnerable are the ones who are most likely to be burned by this injustice, people who are poor, people who live in rural communities, people of color.

MCCAMMON: The bill passed Georgia State Senate and is awaiting a vote in the House. K AG Baby Yee is a Georgia based advocate with the reproductive rights group URGE.

K AGBEBIYI: As soon as the FDA made medication abortion more accessible, Georgia pretty much turned around and was like, no. We actually want to make it really difficult for people to get them.

MCCAMMON: Agbebiyi says medication abortion may become the only option for a growing number of people in states where clinics are few and far between because of abortion restrictions.

AGBEBIYI: We know and our opponents know that medication abortion is going to grow in popularity if Roe was overturned. And that's precisely why they're trying to put as many barriers in place as possible.

MCCAMMON: It's more difficult to put up barriers on the internet, where abortion pills are available through mail-order pharmacies and other groups. Ushma Upadhyay, a reproductive health researcher at the University of California, San Francisco, says if states try to block access to abortion pills, patients will find them online without a doctor's help.

USHMA UPADHYAY: And people will be using it on their own without clinical support. That is what I'm concerned about. It is extremely safe. But all patients should have access to clinical support if they need it, if they have questions about how to take it or whether what's happening is normal.

MCCAMMON: Meanwhile, some states are trying to make access to medication abortion easier. A bill moving forward in Delaware would allow a wider array of health care providers to prescribe the pills to their patients.

Sarah McCammon, NPR News. Transcript provided by NPR, Copyright NPR.

Sarah McCammon
Sarah McCammon is a National Correspondent covering the Mid-Atlantic and Southeast for NPR. Her work focuses on political, social and cultural divides in America, including abortion and reproductive rights, and the intersections of politics and religion. She's also a frequent guest host for NPR news magazines, podcasts and special coverage.