Today, Explained - Abortion pills

Episode Date: June 28, 2022

It’s safe and easy to end a pregnancy during the first trimester using a pair of FDA-approved pills. Accessing them is the latest abortion battleground. Vox's Rachel Cohen explains. This episode was produced by Miles Bryan, edited by Matt Collette, fact-checked by Laura Bullard, engineered by Efim Shapiro, and hosted by Sean Rameswaram.Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Today is a, it's not hyperbole, it suggests a very solemn moment. Just a few hours after the Supreme Court of the United States overturned Roe v. Wade, President Biden addressed the nation. He wanted to talk about pills. Some states are saying that they'll try to ban or severely restrict access to these medications. He wanted to make sure people knew he would fight for access to abortion pills. But extremist governors and state legislators are looking to block the mail or search the person's medicine cabinet or control a woman's actions by tracking data on her apps she uses are wrong and extreme and out of touch with the majority of Americans. Ahead on today explained abortion pills,

how they work, how to get them, and the battle over access. Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started. Rachel Cohen, senior policy reporter at Vox, the Supreme Court overturned Roe on Friday. That means millions of people in America no longer have access to a clinic that can provide a safe legal abortion. What are those people's options other than, say, getting on a plane, getting in a car and driving to a state that will provide an abortion. So the biggest alternative option for people who no longer have in-person clinic care, and to be clear, there are still clinics open, but more states are moving to ban abortion entirely now that Roe's overturned.

The big sort of alternative option is what's known as medication abortion. These are two drugs. One's called mifepristone, the other's called misoprostol. My provider told me that I could take mifeprex, or MIFI, on the first day. Then, about 24 to 48 hours later, I would take the second medicine, the four misoprostol pills. You're effectively inducing a miscarriage. You're ending your pregnancy by producing the same physical experience as having a miscarriage. Miffy ends a pregnancy by blocking progesterone. The second pill makes the uterus contract like it does during a period,

and the pregnancy gets pushed out of the body. Okay, so mifepristone and misoprostol. Are these kind of like plan B, like the morning-after pill situation? They're not the same. It's important to understand the difference. Plan B, the morning-after pill, is what we call emergency contraception. And those prevent a pregnancy. Mifepristone and misoprostol end an early-stage pregnancy. So that's the difference. How often are Americans using these pills?

They now account for more than half of all U.S. abortion. And that's for, you know, a couple of reasons. One is that they can be a lot cheaper than getting in-person abortion care. They can be a lot more accessible. You can get them in the mail. So if you live really far from a clinic, you can get it that way. And some people just prefer to do the whole thing in the comfort of their own home. What kind of abortions are these useful for? The drugs are recommended to be used in the first 10 to 12 weeks of a pregnancy. So that's the first trimester. But I think it's also

important to know that over 90% of abortions do occur in the first trimester. You know, it overlaps well. When you can use the pill safely also overlaps when most abortions happen. Are these pills safe? They're very safe. Decades of research has shown that it's a safe way to end a pregnancy with very little risk of complications. Less than 0.4% of patients required hospitalization, according to the Guttmacher Institute. The National Academies of Sciences has also affirmed it as a very safe method to end a pregnancy. So, you know, as long as you take it sort of within the recommended

time of first 10 to 12 weeks of a pregnancy. For the vast majority of people, not everyone, but for most people, it's a very safe option. How long have mifepristone and misoprostol been around? So misoprostol has been around since the early 1970s. It's used for all sorts of things. It was first developed in the U.S. to treat stomach ulcers. It's sold over the counter all over the world for all sorts of things. It was first developed in the U.S. to treat stomach ulcers. It's sold over the counter all over the world for a lot of things. It's also used to manage miscarriages.

The history of learning to use these pills was in the late 1980s and early 1990s in Brazil. They learned sort of how to use these pills to induce abortions because it was illegal in Brazil and they couldn't do it in a hospital, you know, in another formal setting. The other drug, mifepristone, that was first approved in the U.S. by the FDA in 2000. So it's been legal for over two decades. There was another generic version of it approved in 2019. So these drugs have been around and but they're more highly regulated in the U.S. than than even in other countries. Why is one more regulated than the other? You know, one has been around for a longer time and used for just a lot of other things.

There's a lot of expert opinion that these drugs are over highly regulated, especially in the U.S. You know, there's lower risk of complications for these drugs, you know, from misuse than like Viagra or Tylenol or penicillin. So there's definitely a lot of people in the U.S. experts who say we should be making these easier for people to access. They're, you know, as safe to use as other drugs we make accessible. But that's where politics comes into play. You mentioned that some countries have these pills available over the counter. Does the United States? You can't get them over the counter. And, you know, in fact, before COVID, we had rules that, you know, they literally had to be dispensed in the presence of a physician. There's been a lot of changes over the last two years,

first because of COVID and then just because of the Biden administration. Since the pandemic, the FDA has allowed abortion pills to be dispensed via the mail to people who need it, although there are still states that have bans on getting it by mail. Texas is one of 19 states that ban abortion visits through telemedicine. Pro-choice groups believe several other states may soon follow. But at least in more liberal states that are friendlier to abortion access, you now can get the necessary recommended dosages without going into a clinic physically. How much do these pills cost? It can vary. It can vary by your state. You know, in some states, it could be covered by your insurance if you have insurance that covers abortion care. U.S.-based providers, it's generally a couple hundred dollars. There

is also a European-based provider that you can order from that offers it for $150. I think the important sort of takeaway to know about medication abortion is that it is generally hundreds of dollars cheaper than in-person surgical abortion because, you know, you're not having to pay for a more expensive procedure and you generally don't need to pay for travel and lodging and some states have waiting periods. And so it's not the right answer for everyone, but there are definitely some economic advantages to it. Since they're not like wildly expensive, I wondered if people keep them around just in case, like in the medicine cabinet along with everything else? Or do you think that might start happening more now? Yeah, so I actually wrote a story about this

last week. This is an idea, it hasn't gone mainstream yet, but there are more reproductive health experts that are saying we do need to be talking about this option more, given what we know about the safety of using the pills and given what we know about the coming restrictions we're going to have. Of course, not everybody can afford to pay $150 up front to have a backup option. And I should say the shelf life of these pills, misoprostol has about a two-year shelf life. Mifepristone has about a five-year shelf life. For some people, paying $150 to have kind of like a backup option in case you have an unplanned pregnancy in your home is a good option. And it can be easier for some people to budget

$150 in advance than have to scrounge up hundreds of dollars in the moment if they realize they're pregnant and, you know, have a time crunch. For other people, that wouldn't make sense. It's unlikely to be covered by insurance in advance. I think to your question, it is an option that reproductive health experts are saying, we should be talking about this more start a conversation with your provider if you live in a state like for example in texas they made it illegal to get pills after seven weeks of pregnancy even though the fda has said it is safe you know through 10 weeks and other international health organizations say it's safe through 12 weeks so if you live in a state where you can't order pills after seven weeks, but maybe

you don't even realize you're pregnant until you're eight weeks pregnant, then having the pills already at home would be a good option in that case. It sounds like there's already a fight over these pills. And my guess is there is about to be a lot more. That is very accurate. Rachel Cohen returns in a minute on Today Explained. Support for Today Explained comes from R.A.M.P. Thank you. the end of every month. And now you can get $250 when you join Ramp. You can go to ramp.com slash explained, ramp.com slash explained, R-A-M-P.com slash explained. Cards issued by Sutton Bank, member FDIC, terms and conditions apply. BetMGM, authorized gaming partner of the NBA, has your back all season long. From tip-off to the final buzzer, you're always taken care of with a sportsbook born in Vegas.

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Please play responsibly. If you have any questions or concerns about your gambling or someone close to you, please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Today explained Rachel Cohen-Vox. With Roe overturned, abortion pills seem like a new battleground between those who want people to be able to access abortion and those who don't.

What's the conversation been like around these pills since Friday? In the last few days, pills have been coming up a lot biden gave a speech on friday saying he was going to work to make sure that these pills remain available nationwide attorney general merrick garland said he was going to use the powers of the justice department to crack down on states trying to ban medication abortion i think a really big question that we don't have clear answers to right now is how these battles between the federal government and the states are going to play out when there's no longer a constitutional right to abortion. How can states ban medicine that the FDA has approved? What rights do states have to set these rules if it's legal in other states? These are all

really uncharted questions that are going to be shaking out in the post-Roe era. Do we know if state governments in states where abortion is now illegal or about to be illegal can go after we both obtain and provide abortions has changed a lot since 1973, thanks to telehealth medicine, thanks to medication abortion, thanks to mail-order pharmacies. So, for example,

while laws around telemedicine generally defer to the location of the patient, if you're a provider in New Jersey where abortion is legal, could you face criminal penalty for mailing pills to a patient who lives in a state where abortion is illegal if the patient traveled to New Jersey for their appointment with you? Or what if the pills were sent to an address in a liberal state like Delaware, and then forward it on through the mail to Texas where it's illegal, either by friend or a mail forwarding service. These are sort of all these questions that it's not clear

who's going to have jurisdiction over which state. And, you know, aggressive prosecutors, people think might be sort of eager to test the limits of the laws of their states. Yeah, it kind of makes me wonder in the Texas case if like someone could sue the United States Postal Service for delivering these pills to someone. Right. I think it's important to sort of point out that the anti-abortion movement's goal is not to have a patchwork of states that are abortion restrictive and other states where you can get abortion. They want to make abortion illegal and inaccessible everywhere nationwide. That is the end goal. And so in this new post-Roe era,

there's going to be efforts to sort of push the limits of how state restrictions can spread into other states. There's going to be efforts to see, okay, can I go after a provider in New Jersey who gave an abortion to, you know, a woman in my state? We don't know yet how those efforts are going to shake out. Have we seen any efforts to police abortion pills and access to them already? Yeah. So a majority of states already have, you know, some sort of restriction on medication abortion. But there are no states that have banned the medication outright. And there's a lot of questions about like whether that would be legal since it's an FDA approved drug. There's a lot of

talk now about kind of trying to do that, especially as now states just ban abortion outright. Up to this moment, most restrictions on medication abortion have been around like how you can get it. Do you have to get it in person? Does it have to be dispensed by a physician? Can it be sent through the mail? At what week, you know, Texas last year, Texas passed a new law saying that you can't get medication abortion after seven weeks in a pregnancy, even though the FDA has approved it up through 10. I'm sure some states are going to try to just ban it outright. Other states are just going to try to keep chipping away to make it harder and harder to access. But the flip side and the sort of the upside

is that it's going to be really, really difficult for them to police now that these pills can be mailed. People will be taking on new risks for each other, but there's going to be an underground passageway of these pills. And that's just a reality that couldn't and didn't exist before Roe. Can pro-abortion states do anything to protect abortion providers or people traveling to their states to seek care? So what we are seeing now in the past couple months, there has been a new effort by Democratic-controlled states to pass what they're calling shield laws, basically different laws to try to protect providers from out-of-state prosecution, from out-of-state complaints. There's all these different ways that if you get too many complaints and you're a medical health provider, then your insurance costs go up. You can lose your license if you have too many different complaints. There's all these different ways that you can get harassed or it can make it too difficult to provide the care. So blue states are

looking at ways to kind of help shield providers in their states from that kind of harassment or intimidation or legal prosecution. It is an open question though right now about whether or not these providers can be held liable for certain harms that red states might allege. I think another important question is like, to what extent does a prosecutor in Alabama have, what powers do they have to actually make a doctor in New York show up at court if the doctor refuses to participate? And we don't really know. How are the people who live in states with strict abortion bans, who aren't traveling

across state lines, typically getting these pills? People living in those states that have restrictions, a lot of them are turning to this nonprofit based in Europe called Aid Access. We have a unique opportunity with Dr. Gompertz being in Europe that we're able to provide telehealth abortion to all 50 states. So Aid Access was founded in 2018 by a physician and abortion provider named Rebecca Gompertz. She has been providing abortion around the world for several decades. I will start now talking a little bit about our work. And I will start with the work of Women on Waves.

And Women on Waves was founded 20 years ago. And the idea was that if you have a ship, then you can go to a country where abortion is illegal and you can take women outside international waters because the local criminal laws don't apply anymore. But she actually avoided helping out the U.S. because unlike many otherpertz had sort of dedicated her career to helping women access abortion pills in states where it was just purely illegal. In 2018, she founded Aid Access because after Trump was elected, people were giving so many requests for help. To date after 2018, I've counseled around 11,000 women, and of these, I provided the prescription for 2,500 women. And so her whole, basically, model is that if you live in one of these states that has restrictions on medication abortion,

well, it's not illegal for her, based in Austria, to dispense the pills. So you can put in a request through Aid Access, and basically, even though Alabama or Texas or prosecutors in Georgia don't want Dr. Gompertz to be sending pills to people living in their states, she's kind of out of their jurisdiction of the law. The drug regulator in America has told you to stop. Will you? As a doctor, I have the obligation to care for patients that reach out to me and that need my

help. And the FDA has no say over my medical practice. So as long as I can help women, I won't And if you're not going with this group Aid Access based out of Austria, are there other places on the Internet? Are there shady corners on the dark web where you can find these kinds of pills? So, you know, I think it is really important to like get vetted medication, you know. So this organization called Plan C Pills, they do a really good job of finding places where you can get safe medication abortion online. I mean, people are going to resort to lots of different methods. We've already seen reports of people crossing into Mexico to get misoprostol where you can get it over the counter. But I would say you definitely want to be careful about what websites you order and make sure that

the online pharmacies are vetted. And I guess in addition to vetting these pills, the other question is privacy, especially when so much of this is happening online. There's been a lot of concern here about how much your data is going to be tracked when you try to secure an abortion online. Do we have any idea how that pertains to pills? Yeah. I mean, this is a really important question. This is a huge difference from pre-Roe times. We just didn't have all this sort of tracking data technology. You know, there was sort of a lot of media attention on things like period tracking apps and stuff like that. But what a lot of digital security experts say is really kind of some of the biggest vulnerabilities that people face is like text messages or emails or things that just like basic things, not even just your internet search history, although that is something should be mindful about your internet searches and so on, especially if you're thinking about potentially trying to bypass a restriction or figure out a legal

loophole. Like, you want to be careful kind of what you're saying, what you're doing that on. A lot of experts recommend using Signal, which is an encrypted messaging app, etc. I think the bigger point is all of these concerns point to the need for the federal government to follow the steps of other countries and pass stronger consumer protection, digital privacy laws. Like we shouldn't be so scared of criminal prosecution for just searching basic questions about health care on the Internet. You know, in talking about this trigger ban situation on the show yesterday, our guests called the current status of abortion in the United States chaos. And now talking to you about the abortion pill situation in the United States, it just feels even more chaotic. Should we just be bracing ourselves for this

deluge of legal battles for the next few years? I think we should. I think not just legal battles, but there's going to be new tactics of resistance and fighting back both, you know, politically and through activism. I think the only thing that we can really say for sure is that we are not just returning to a pre-1973, pre-Roe v. Wade time. Many anti-abortion activists and conservative legal scholars have sort of long said that if we just overturn Roe v. Wade, then we're going to have this simpler legal landscape. We're going to kind of free the courts from this abortion umpiring business, as Justice Scalia said, you know, back in the 1990s. This idea that we'll just let states decide, but that's really just

not going to happen. We're going to have a much more chaotic landscape and we're probably going to have this all wind up back at the Supreme Court again to weigh back in on these questions about out-of-state prosecutions and what right states have to regulate conduct of their own citizens. So you're saying this is going to be a total shit show? Unfortunately, yeah, probably. Rachel Cohen, Vox.com. Our show today was produced by Miles Bryan, edited by Matthew Collette, fact-checked by Laura Bullard, and engineered by Afim Shapiro. The rest of the Today Explained team includes Paul Mounsey, Halima Shah, Avishai Artsy, Hadi Mawagdi, Victoria Chamberlain, and my co-host, Noelle King.

Extra help this week from John Ahrens. Our audio fellow is Tori Dominguez. Our supervising producer is Amina Alsadi. Vox's VP of audio is Liz Kelly Nelson. We use music by Breakmaster Cylinder. And now I'm Hassenfeld. I'm Sean Ramos for him. Today explained as part of the Vox Media Podcast Network, and we're on the radio in partnership with WNYC. © transcript Emily Beynon