The pro-abortion strategy hinges on pills. A lack of information threatens their efforts.

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Pro-abortion and anti-abortion groups expecting Roe vs. Wade Whether to be limited or canceled this summer, proponents have increasingly focused on the pills as one of the next fronts in the 50-year battle over the right to terminate a pregnancy.

Nonprofits and activist groups are posting online guides to getting the pills, staging pro-pill protests outside the Supreme Court and across the country, buying ads this month on New York’s subway York and drive mobile billboards throughout Texas. Organizations are recruiting volunteers and hiring staff for 24-hour helplines that guide people through the process of taking abortion pills, in anticipation of an increase in demand. Some doctors’ associations are launching nationwide campaigns in May teaching members how to prescribe the pills and urging them not to turn patients over to law enforcement. Organizations that help low-income people pay for abortions are raising millions, in part to help buy the drugs, which can cost upwards of $500.

Proponents say the new availability of FDA-approved abortion pills that can be prescribed online and mailed to patients’ homes could be what’s keeping people from returning to a pre-deer a time when back alley surgeries, herbal concoctions, and coat hangers were among the only options.

But that will only happen if more people know about the pills, known as mifepristone and misoprostol, and can access them.

“There are so many people who don’t even know mifepristone exists,” said Ushma Upadhyay, associate professor and obstetrician/gynecologist at the University of California, San Francisco, who is leading a study on the use of abortion pills. in 20 states. . “They still imagine dramatic surgery when they think of abortion.”

Anti-abortion groups have also focused on the pills, successfully lobbying dozens of states to enact bans and create websites, ads and movies to dissuade people from using them. Over the past few weeks, they’ve celebrated pill restrictions passed in Kentucky, Georgia and South Dakota.

In a statement, Susan B. Anthony List President Marjorie Dannenfelser said such bans are “vital to stopping the proliferation of dangerous mail-order abortion drugs that put both unborn children and their mothers at risk.” .

Still, pill orders are rising, especially during the pandemic, as patients sought to avoid all sorts of in-person care and several GOP-led states imposed restrictions that made physical abortion clinics harder to access. access. This year, drugs have become the most popular method of ending pregnancies in the United States

Yet despite increased use, only one in five adults have heard of medical abortion, according to the Kaiser Family Foundation. And even many who are in the know are discouraged by a wave of state bans on drugs and fear the consequences of their use.

The recent arrest of a young woman in Texas, who was charged with homicide and held on $500,000 bail after self-administering her abortion, has heightened those concerns. While those charges were quickly dropped after local activists mobilized, abortion rights advocates said the story could scare patients away from taking the pills and scare doctors away from treating those who have them.

Bhavik Kumar, doctor in Texas, who sits on the board of Physicians for Reproductive Health, said The law allowing private citizens to pursue alleged illegal abortions has struck fear and confusion in the medical community and fueled cases like the arrest earlier this month of 26-year-old Lizelle Herrera, who was reported to law enforcement. the order by the medical workers she transformed for care.

“The fact that there can be a lawsuit against anyone aiding and abetting an abortion clouds the waters,” he said, referring to the Texas law that several states seek to copy and which uses private lawsuits like enforcement mechanism. “Some providers worry about what constitutes help and encouragement, even after the abortion has taken place. And certainly one of my concerns is that, especially people of color and undocumented people who have already struggling to access health care, when they hear about a case like Herrera’s in the media, they may be afraid to seek care when they need it after an abortion.”

Medical and advocacy groups that successfully petitioned the FDA last year to lift restrictions on mail delivery of drugs point to studies that show the pills are about 95% effective in terminating a pregnancy and have a complication rate of less than 1%.

The pills, however, can only be used within the first 10 weeks of pregnancy, which means that by the time many people realize they are pregnant and figure out how to get them, it may be too late.

April Lockley, medical director of the Miscarriage and Abortion Hotline, a phone and text line that supports people who decide to self-manage abortions, said many who call are unsure of their options.

“Some people specifically say, ‘I’m looking for medical abortion pills,’ but other people basically say, ‘I’m pregnant, I don’t want to be, and I don’t know what to do.'” she says.

But even when a patient is within this window, several obstacles remain.

Patients in states with restricted access to pills must cross state lines, lie, or omit information about their whereabouts during a telehealth visit with an out-of-state provider. state, or buying pills from a foreign pharmacy – options that may carry some legal risk for the patient.

While Planned Parenthood and some other providers who prescribe the pills have set up hotlines and posted medical information online, many patients are unaware of them and some go to the emergency room after taking the pills to determine if the procedure was successful or to ask if their bleeding is normal.

“They need to know what number to call if they need us, that we’re here 24/7, and that there are no dumb questions,” said Danika Wynn Severino, vice – Chair of Abortion Access for the Planned Parenthood Consortium of Abortion Providers. . “Patients want to know they will be safe. They want to understand what is happening to them.

Patients who tell their doctors they took pills in a state where their use is criminalized could find themselves in legal danger. Although physicians are not required by any state law to report self-directed abortions to law enforcement, providers may mistakenly believe they are, so advocates have begun teaching patients how protect themselves if they seek post-abortion care.

“I tell my patients it’s always best to be honest,” said Kumar, the Texas abortion provider. “But I understand why, in the current climate, they may not want to fully disclose things. So I also tell them that the drugs used in an abortion are not detectable by a blood test and are indistinguishable from a miscarriage.

Another major flank of abortion rights advocates focuses on medical providers, many of whom learned little about abortion in school or have an outdated understanding of the options.

Innovating Education in Reproductive Health, a program of the UCSF Bixby Center for Global Reproductive Health, released a series of videos titled “When Abortion Isn’t Available,” to educate providers in states where in-clinic abortions aren’t available. not allowed or are restricted on how to help patients. Another group, Physicians for Reproductive Health, is launching a three-month nationwide campaign in early May aimed at doctors unfamiliar with or wary of abortion pills.

“People trained in the 60s and 70s saw the tragic and unfortunate circumstances of what people who self-managed their abortions looked like before medical abortion was legalized and invented,” said Acting Director Kelsey Rhodes. group communications. “Too many physicians have a picture in their minds of what self-managed abortion is that doesn’t match today’s reality.”

With a Supreme Court ruling looming and with up to half of the states set to join Texas in banning most or all abortions, the use of the pills is expected to increase. Yet activist and medical groups that support abortion rights worry that the legal and educational infrastructure is insufficient to make drugs a real option for millions of people.

“We’ve had a state where abortion was actually banned, but not technically banned, and we’ve seen the added barriers, burdens, harms, and impact that has on people,” said Andrea Miller, President of the National Institute of Reproductive Health. “Multiply that by a magnitude of 10 – much less the potential magnitude of up to half of the states – there is no doubt that these kinds of available resources need more support.”

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