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Sean Locke / Stocksy
  • The heartbeat abortion ban in Texas has made it difficult for pregnant people to obtain needed abortion services.
  • One way people are getting around the ban is by obtaining abortion drugs online.
  • Experts say medical abortions are an FDA-approved, safe method to terminate a pregnancy.
  • Organizations such as Plan C and Aid Access might be able to help people obtain safe, inexpensive abortion services even when restrictive laws exist.

Abortion has long been a contentious issue in America. Since the landmark 1973 U.S. Supreme Court ruling Roe v. Wade, anti-abortion groups have fought hard to see the verdict overturned, while pro-choice advocates have fought just as hard to protect it.

Now, several states seem to be making headway in the battle against abortion rights, in particular the state of Texas, which passed a so-called “heartbeat” abortion ban, which prohibits abortion once cardiac activity has been detected, usually around 6 weeks into the pregnancy.

The ban is controversial because people often do not even know they are pregnant until well after 6 weeks into their pregnancy.

Julie Novkov, PhD, JD, a professor of political science and women’s, gender, and sexuality studies at the University at Albany, SUNY, said things are “very uncertain” right now regarding this new legislation.

“Clinics tried to prevent the law from going into effect by asking courts to enjoin it while lawsuits were going on to determine its ultimate constitutionality,” Novkov said

However, on Oct. 14, an appellate panel for the U.S. Court of Appeals for the 5th Circuit allowed the law to continue operating.

In addition, the U.S. Justice Department has asked the U.S. Supreme Court to intervene and reverse the 5th Circuit’s ruling.

“Right now, the court is considering two issues,” said Novkov. “Whether to let the law continue to be operational while challenges are working their way through court, and whether to consider a substantive challenge of the law itself that abortion providers have launched.”

As to where things could be going in the future, it’s “hard to say,” Novkov said.

In the meantime, though, there may be another option available to Texas people seeking to terminate their pregnancies: medical abortion via telemedicine.

Medical abortion is done using two drugs: mifepristone and misoprostol.

According to Dr. Emily Godfrey, MPH, an associate professor in the Department of Family Medicine and the Department of Obstetrics and Gynecology, Division of Family Planning at the University of Washington, says mifepristone works by blocking the hormone progesterone, which keeps an early pregnancy from progressing.

Misoprostol is a prostaglandin medication that induces uterine contractions to expel the pregnancy.

This medication regimen has been approved by the Food and Drug Administration (FDA) since 2000.

Godfrey said the procedure is generally considered to be safe, with less than 1 percent of people who use it having significant complications.

These types of abortions have been on the rise in recent years, and many people going to clinics for an abortion would be able to choose this type of abortion versus a more invasive procedure.

With the Texas law in place, people who wish to end their pregnancy may turn to telemedicine options to obtain a medical abortion.

Plan C is an advocacy organization that provides people with information on how to obtain abortion pills.

Godfrey said a medical abortion is appropriate for almost everyone still in their first trimester of pregnancy who does not have contraindications to either of the medications, such as an allergy. It is FDA-approved for use in the first 10 weeks of pregnancy.

Anyone who is taking blood thinners or having symptoms of a potential ectopic pregnancy should not use them, however.

People taking steroid medications regularly or who have severe anemia should consult a physician before undergoing a medical abortion.

Anyone who has an IUD should have it removed before taking the pills.

The Plan C website offers several creative suggestions for obtaining a medical abortion. However, the simplest and least expensive method appears to be going through an organization called Aid Access.

Aid Access is an online telemedicine service for people who want to do a self-managed medical abortion.

For a $110 fee, a licensed doctor in Amsterdam will write the prescriptions for the medications, and they are shipped from a reputable pharmacy in India.

The website provides a helpdesk and doctor to answer any questions during any stage of the process.

Godfrey noted that a small number of people might have complications during a medical abortion, such as prolonged bleeding or cramping or a failed abortion.

If they have heavy bleeding (soaking two pads an hour for more than 2 hours in a row), she said they should seek medical evaluation as soon as possible.

They should also see a healthcare professional if they feel ill, have abdominal pain, vomiting, diarrhea, or a fever greater than 100.4°F (38°C) for more than 24 hours after using misoprostol.

If a person has continued bleeding for more than 4 weeks after their abortion, they should visit a healthcare professional.

If the person does not have any bleeding after 24 hours of taking the misoprostol pills, they might also consider reaching out to their physician, she said.

She did note, however, that statistically, medical abortion pills are about 30 times safer than carrying a pregnancy to childbirth.

Novkov said that while it is illegal in Texas to perform a medical abortion after a fetal heartbeat has been detected, it would be hard to enforce the law.

Because the prescriptions come from a doctor based in Europe and ship from a pharmacy in India, she said that enforcement would raise complicated extradition problems.

In addition, the law targets abortion providers rather than the person seeking the abortion, she said.

Godfrey agreed, noting that the law specifically exempts the person getting the abortion from being sued.

In addition, she said it would be completely legal if all Texas residents obtained the pills before they became pregnant.

“It is important to note,” said Godfrey, “that the notion of providing abortion pills in ‘advance’ of an event is no different than what physicians do when they prescribe an EpiPen to patients who might have severe allergies to a beesting or antibiotics in advance of international travel.”

She added that these pills could be obtained through a service like Aid Access.