Aborting a pregnancy in 14 states leaves few options. Some seek help in Europe and India.

The tablets came in a dark salmon envelope sealed with a plastic lid that traveled over 7,000 miles, over a dozen time zones from Nagpur, India, in almost exactly one week.

They were partly placed under the rug at home in a state with one of the strictest abortion bans in the United States, where drugs are not dispensed from clinics or pharmacies, and the closest option for an in-person procedure is at least an hour later. four hours of travel.

Advocates say it’s one of the few remaining options for those seeking an abortion in one of 14 states that criminalize medical professionals who perform the procedure.

The process for ordering a medicine at Aid Access, a non-profit organization founded by Dr. Rebecca Gomperts in 2018, is broken down into segments. From the organization’s headquarters in Austria, Gomperts acts as a gynecologist, writing prescriptions for a person ordering pills on the Aid Access website. It’s one of the few services that allows people to order “just in case” medicines, as if properly stored, pills don’t expire within two years.

The $105 (around €98) payment is made separately via PayPal, and once the payment is completed, Gomperts sends the prescription to the pharmacy. There is also a financial aid option.

Mifepristone and misoprostol are used in combination to terminate a pregnancy, usually before 12 weeks of gestation, and the drugs are used to treat early miscarriages. First, mifepristone is taken to stop the production of the hormone progesterone needed to continue the pregnancy. Misoprostol is then taken to induce uterine contractions and expel the pregnancy.

Mifepristone was approved by the U.S. Food and Drug Administration in 2000, but it is currently being challenged in court and legislatures across the country are trying to limit access to the drug. On Friday evening, the Governor of Wyoming signed into law ban on medical abortion. Trial challenging the FDA approval process for mifepristone continues in Texas, where a federal judge could order the agency to withdraw its approval after more than two decades. Other states are trying to restrict access by threatening legal action against retail pharmacies and any other drug providers.

When a parcel is sent, an email notification is sent with detailed instructions on how to take the medicine, potential risks, side effects and pain relief, and when to seek medical attention. The email also includes resources for hotlines with people who can provide emotional support or provide answers to medical questions.

The package itself contains a box containing one mifepristone tablet and four misoprostol tablets, while the individual package contains 12 misoprostol tablets. The combo box is sufficient for pregnancies less than 12 weeks and 12 tablets are for pregnancies greater than 12 weeks.

By email, Gomperts told Newsroom states that her organization receives more than 1,000 emails a day from people who need help. Many of them also cannot afford the full cost of drugs. Gomperts said in February that 57% of those who paid for drugs could pay less than 50 euros, or about $53.

“It’s important to continue this work because the people we help can’t travel to other states to get a safe abortion,” Gomperts said.

Alabama has already threatened legal action under another law for taking abortion pills.

Gomperts grew up in the Netherlands and became interested in abortion care while working at Greenpeace. The newspaper “New York Times. She worked to organize abortions for women in countries around the world, including Spain, Morocco, Guatemala and Ireland, when the country still had a strict ban on abortion.

Kristin Ryan, Legal Director Global Center for Justice, from Ireland and told Newsroom States that she was still living there when the abortion ban was in effect. It was canceled in 2018 following the high-profile case of a woman who died of a septic infection after being denied an abortion during a miscarriage.

Ryan said that seeing these events and Gomperts’s work forced her to get involved in reproductive rights.

“Rebecca Gomperts has been a guardian angel for women all over the world for decades,” Ryan said.

Gomperts used the same “workaround” to send drugs to Irish women when it was illegal, Ryan said, since she lives in another country.

Thirteen US states have bans on abortion, nine of which have no exceptions for cases of rape or incest. The bans do not provide criminal penalties for pregnant women, and while Texas, Oklahoma, and Idaho have civil laws allowing family members or a pregnant woman to sue healthcare professionals for their role in an abortion, claims cannot be brought against a pregnant person.

This has not stopped some states from threatening to prosecute individuals for taking abortion pills under various existing laws. This was announced in January by Alabama Attorney General Steve Marshall. the state can persecute people under the Chemical Threat Act, which was used to prosecute women who use illegal substances during pregnancy. It is unclear whether this law will apply to mifepristone and misoprostol, which are FDA-approved legal drugs. The US Department of Justice also issued an opinion in December, an allegation that drugs were being mailed to a particular jurisdiction was not sufficient evidence to “conclude that the sender intends to use them illegally.”

The Wyoming Legislature also passed a ban on medical abortion in March, which Gov. Mark Gordon signed into law on Friday.

While Politico and the New York Times reported this month that Walgreens has confirmed it will not sell the drug in 20 states where attorneys general have threatened legal action for doing so, a Walgreens spokesperson said in a Newsroom statement to the states: “We want to be very clear about what our position has always been is: Walgreens plans to dispense mifepristone in any jurisdiction where it is legal to do so. Once we receive FDA clearance, we will dispense this drug in accordance with federal and state laws.”

While this will make it harder for people to get mifepristone at the pharmacy, Ryan said it won’t be easy to enforce the ban on mail-order pills.

“Authorities in (states where abortion is illegal) – who are they going to prosecute for sending these pills in the mail?” Ryan said.

Idaho anti-abortion activist: We need punishment for sending ‘human pesticides’ to women

Brandi Swindell, founder and president of anti-abortion clinic Stanton Healthcare, told Newsroom she sees mail-order abortion pills as a serious problem, which she called “creepy” and reminds her of a drug cartel.

“We have groups not only out of state, but also out of the country, who are pimping pesticides for people, which can have very serious consequences for a woman physically and emotionally, can affect her mental health, her physical well-being.” Swindell said. “And they’re coming to states where we have clear abortion laws, where we’ve gone through the legal process, the legislative process. … And they will try to sell and sell these drugs, preying on women who are in a potential crisis or unexpected pregnancy situation, in a vulnerable position.”

Idaho has a near total ban on abortion at any stage of pregnancy, with positive court protections for saving a pregnant woman’s life, and for rape and incest if a police report is produced. Swindell said she is working with lawmakers in Idaho, where Stanton Healthcare is based, to get an opinion from Idaho Attorney General Raul Labrador’s office on whether the state’s abortion ban includes medical abortion.

“It needs to be made clear and enforced that any organization or individual involved in promoting, selling, or profiting from attempts to circumvent Idaho’s law on the issuance, sale, and profit of an abortion pill must be held accountable.” – Swindell . said.

If the Labrador office decides the method is not included in Idaho law, Swindell said legislation needs to be passed as soon as possible to strengthen existing law before the Idaho Legislature adjourns for a year, which could happen in the next few weeks.

“We are working hard to get chemical abortions banned,” Swindell said. “We want to make this a top issue in the 2024 presidential race.”

Do-it-yourself abortions at home help pregnant women feel more secure, lawyer says

Over the past three years, the use of the drug has become much more common in abortions across the country. According to the Guttmacher Institute, as of DecemberMedical abortion accounted for about 54% of all abortions in the US.

Part of that may be because people are taking advantage of these mail-order legal workarounds, but Ryan said some pregnant women find that home abortion management is empowering and gives them a stronger sense of security.

“You’ve had clinics suffering from this type of violence in a clinic setting and having to deal with protesters and having difficulty arranging transportation and financing transport when managing a pregnancy in someone’s own home is a safe place,” Ryan said. “Also, having access to a doctor over the phone and online is something that has proven to be quite helpful.”

As healthcare professionals and patients in the United States wait for a decision from a federal judge in Texas to approve mifepristone by the U.S. Food and Drug Administration, advocates want to emphasize that options such as access to care will continue to be available regardless of the outcome. court case. .

Dr. Jennifer Lincoln, an OB/GYN practicing in Portland and executive director of advocacy organization Mayday Health, said if state laws become stricter on abortion drug control, access to care and other international options will become more important.

“The best thing you can do is educate yourself and get the message across that you will still be able to get these medications,” Lincoln told Newsroom. “It requires a few more hoops, but you can still get it.”

Ryan isn’t worried that organizations like Aid Access might be affected by what’s going on in US courts, but she does worry that state and county prosecutors are trying to prosecute people who take pills at home.

“What I do find particularly difficult (fact) that activists and patients in the US have to deal with, that was not so relevant somewhere like Ireland or even Mexico and Argentina, is the level of surveillance and power that exists. and the zeal of the criminal justice system,” Ryan said. “This phenomenon, which largely coincides with the human rights crisis, creates an extremely difficult environment for people to exist.”

State news reporter, national reproductive rights reporter Sophia Reznik contributed to this report.