The Future of America’s Abortion Fight

[0] From the New York Times, I'm Sabrina Tavernisi.

[1] This is the Daily.

[2] It was a devastating hearing for millions of women across this country who are watching the Supreme Court look like they are going to overturn Roe v. Wade and take us back into the days of back -alley abortions.

[3] This is a tremendous opportunity.

[4] We are asking the court to overturn Roe v. Wade, and it's time.

[5] It's been nearly 50 years.

[6] Supreme Court appears set to dramatically roll back abortion rights.

[7] Later today, federal regulators are expected to issue a ruling that could significantly expand them.

[8] I spoke with my colleague, Pam Bellick, about what that decision will mean for the future of the abortion fight in America.

[9] It's Thursday, December 16th.

[10] So Pam, we're at a moment in our country right now where we are fundamentally rethinking the laws around abortion.

[11] And we're looking to next year to a potential reality where Roe, you know, the 1973 decision that made abortion legal nationally, could very well be overturned and abortion would become illegal immediately in many states.

[12] And of course, those who oppose abortion would see that as a real victory.

[13] But people who support abortion rights are really worried.

[14] You know, they say that it would mean going back to the time before Roe when, abortions were really quite dangerous.

[15] And I guess my question for you is, is that right?

[16] How do women get abortions these days?

[17] What does it look like out there?

[18] Yeah, a lot of things have changed since the 1970s.

[19] First of all, for the last 30 years, the abortion rate has been declining.

[20] Now we have about 900 ,000 abortions per year in this country, and the abortion rate is less than half of what it was in 1980.

[21] The other major thing that's changed is the method.

[22] Before abortion was legal, it was often very unsafe for women who sought abortions.

[23] And that's why we have the image of the coat hanger and back alley abortion.

[24] After Roe, when abortion became legal, the vast majority of abortions required women to have a surgical procedure that was performed in a hospital or a clinic by a doctor.

[25] But in 2000, because of medical advancements, the FDA approved what is known as medication abortion.

[26] And they have grown in prevalence, and they now account for more than 40 % of all abortions in the United States.

[27] Oh, wow.

[28] So what is medication abortion?

[29] So medication abortion involves two pills that women can take when they are up to 10 weeks pregnant.

[30] And to give you a sense of when women get abortions in this country, about 80 % of abortions occur within that time frame in this country.

[31] Wow.

[32] So an overwhelming majority of abortions are theoretically eligible for this medication abortion method.

[33] That's right.

[34] But there has been one big hitch.

[35] which is that the first drug that you take is very, very strictly regulated by the FDA.

[36] That drug, it's called Miphyprisone, it blocks a hormone that's essential to pregnancy, so it sort of stops the development of a pregnancy, has been so strictly regulated that women have been compelled to go in person to a specially certified doctor to pick up a that pill.

[37] And they can take the pill anywhere they want to, but they have to go to a doctor in a hospital or a clinic who is specially certified in order to get it.

[38] Now, for years, medical experts and major organizations like the American College of Obstetricians and Gynaecologists and the American Medical Association have said that there's years of data that show that medication abortion is very effective and very safe.

[39] And they have been pushing for quite a while to get Miphypristrone treated like any other drug.

[40] They say it is the only drug that the FDA regulates out of something like 20 ,000 drugs where you have to pick it up in person, but you don't actually have to take it in front of a physician.

[41] You can take the drug anywhere you want to.

[42] So for years now, this has been, something that these organizations have been pushing for, and yet women have still, in most cases, had to go into a doctor's office to pick up this medication.

[43] But the pandemic changed that.

[44] Because during the coronavirus pandemic, everybody was concerned about limiting unnecessary medical visits because it put people at risk of getting infected with the virus.

[45] The These major medical organizations saw an opportunity to press the FDA to try to lift this restriction.

[46] They made the argument that it was putting women at unnecessary risk if they had to go to a doctor's office to get a drug when it wasn't necessary for safety reasons for them to get the drug at the doctor's office.

[47] And so after some back and forth in the courts, the Trump administration, was fighting it, but when the Biden administration came in, the FDA decided to temporarily lift the in -person requirement for picking up the drug for the duration of the pandemic.

[48] And now, today, we are expecting a decision from the FDA about whether it will permanently lift that in -person requirement, and also whether it might lift any of the other restrictions that apply to Miphyprostone.

[49] Interesting.

[50] What do you think it would mean if they did make that permanent?

[51] I mean, how meaningful is the barrier of having to see a doctor in person for that first pill?

[52] Well, for some women, it is very meaningful, especially people who don't have a lot of resources or a lot of time.

[53] it can be an important barrier if you have to take time to go to a doctor's office and if you have to go to one that is specially certified then that one might be a lot farther away so that can be a big barrier so instead of having to do that this allows women to have a virtual telemedicine appointment with a doctor who can then prescribe her the pills and mail them to her at her home or any location where where she wants to receive them.

[54] And the other aspect of this is that because you can take abortion pills in the privacy of your own home or in your office or your car, wherever you want to, not having to go to a clinic allows you to avoid maybe encountering abortion protesters or just sort of allows you to be more private in undertaking this procedure.

[55] And so for a lot of women, medication abortion is an appealing method to use because it allows them to be private.

[56] So Pam, it sounds like if the FDA does decide to permanently change the rules and say women don't need to go into a doctor's office to get this first pill, that the barrier to getting an abortion in America would get lower, which would mean that the medication abortion would become even more common as a method.

[57] So I guess when I think back to the 1970s, I mean, that's just a really different picture, right?

[58] It's not the image of abortion that comes to mind when you think of the fight today and how people on both sides are presenting it.

[59] Right.

[60] I think the public debate has not really reflected these changes that have been happening over the last few years with medication abortion.

[61] And if this barrier is lifted permanently, that will be a really significant step.

[62] But, as with everything involving the abortion issue, it's a lot more complicated than that.

[63] We'll be right back.

[64] So, Pam, what would this actually mean in practice?

[65] I mean, if this rule was relaxed permanently, if you're in Texas or in Mississippi or in one of the other 19 states where, abortions being restricted.

[66] Could you just telemedicine a doctor in California and that doctor mail you pills?

[67] No, it's not really that simple, although I think it's possible that a doctor in California or a state like California will try that.

[68] But what you have is a real patchwork of laws that varies state to state.

[69] There are different laws on abortion.

[70] There are different laws on telemedicine.

[71] So right now there are 19 states where it is not possible to have a telemedicine appointment with a physician and get abortion pills then sent to you by mail.

[72] So even if the FDA lifted that restriction, there are 19 states, most of them in the South and the Midwest, that would prevent that from happening through one or two different kinds of laws.

[73] Then you have about 20 states where it is legal to have a telemedicine appointment with a doctor in your state or a doctor who is licensed in your state, even if they're not physically located there.

[74] And that doctor can then write a prescription and you can get those pills sent to you by mail.

[75] So in 19 states, this ruling wouldn't really change very much, it sounds like.

[76] it would be illegal to get these pills in the mail from doctors in your state or from doctors in a different state.

[77] Right.

[78] But if you're living in a state where you are not allowed sitting at home to have a telemedicine appointment with a doctor and have that doctor send you abortion pills, you could travel to another state where that is allowed.

[79] And that would likely be less expensive and a bit easier for you than traveling to a state where a surgical abortion is allowed and getting an appointment at a clinic and having to have surgery, which is what women in states where abortion is restricted do now.

[80] So if you have to travel to a state in order to get an abortion, it's going to be easier for you to do that under a system where you can just sit in a hotel room in that state or your cousin's house or even just kind of sit in your car and have your telemedicine appointment and have the pills mailed to a post office box address and it will be less expensive than getting a surgical abortion.

[81] So for some women in those states where it's banned, I think it's easier than having to go to another state to get a surgical abortion.

[82] And also, it's harder to enforce a law against receiving something in the mail, you know, unless somebody's going to open every package, which doesn't happen, it's easier to get around that sort of thing.

[83] So you can see a situation where somebody could go to a state where it's legal, you know, sit in their car, even do the telemedicine appointment, give the doctor there an address in that state.

[84] Maybe it's a friend or a relative.

[85] And then maybe that relative could send it to you.

[86] I mean, force, Some women will make access easier, even if they're living in a state that prohibits it.

[87] Right.

[88] So this ruling could make it easier for people to get these pills legally, but also illegally, because this whole realm of telemedicine and getting pills through the mail is just much, much harder to police.

[89] Yes, I think that's right.

[90] However, if the FDA does permanently lift this restriction, I think we will see a whole.

[91] series of reactions on both sides of the abortion debate that could change the landscape in unpredictable ways.

[92] How do you mean?

[93] Well, I think that states that are conservative and are inclined to restrict abortion will unleash as many different ways as they can think of to try to further restrict access to medication abortion.

[94] You're already seeing that during the pandemic and during this past year, so far six states have adopted bans on the mailing of abortion pills.

[95] Oh, wow.

[96] And four states have adopted laws that try to restrict how late you can get a medication abortion, in some cases like in Texas trying to roll it back to seven weeks.

[97] On the other side, in states that favor abortion rights, you're going to see a kind of flowering of efforts to try to take advantage of this.

[98] Again, you're already seeing that in the last year or so, since the restriction on Miffra Pristone was temporarily lifted, you have organizations like Hey Jane and Abortion on Demand, and these are online sites where if you live in a certain number of states, you can get online, get access to telemedicine, consultation and get abortion pills mailed to you legally.

[99] Wow, so it's kind of a cottage industry springing up on the internet where the main reason these organizations exist is to make it easier to get these abortion pills.

[100] Exactly.

[101] And another thing that we're going to see in states where medication, abortion by mail is illegal, is something, again, that we're already seeing.

[102] There's an organization called Aid Access, which is based in Europe.

[103] And it will allow women to go online, fill out a form, they can get a doctor to prescribe pills that if they live in a state where it's illegal, those pills will be mailed from a pharmacy in India.

[104] And the FDA has tried to restrict aid access for the last couple of years, but it's very hard to do that.

[105] I think they've intercepted maybe a few packages of pills, but it's very hard.

[106] for them to know where they're sending these pills to.

[107] And then recently, the head of Aid Access, a doctor named Rebecca Gomperts, has actually started doing something else in the United States where she's been sending pills to women who are not yet pregnant just to sort of have, you know, kind of on hand in the event they have an unplanned pregnancy.

[108] And so this is a little bit of a more kind of edgy step, but it is starting to gain some acceptance among abortion rights advocates in the United States who say, hey, you know, we do this with some other drugs, you can keep it in your medicine cabinet, why not do it with abortion pills?

[109] Wow, like getting CIPRO before you go on a trip to some developing country.

[110] Exactly, but I think that it's pretty unlikely that the FDA would authorize this kind of thing anytime soon.

[111] And, you know, for one thing, there's certainly going to be questions about how do you make sure when they're using the pills correctly, taking them within 10 weeks and not 12 weeks, that sort of thing.

[112] But this is an example of the kind of thing that we're going to see debated.

[113] And I think both sides will continue to push the envelope and come up with creative ways to take advantage of whatever the new legal reality is.

[114] You know, Pam, I've reported a lot on the abortion battles, as you know, and I'm thinking about this.

[115] And it really strikes me that for a long, long time, the fight was this real kind of visceral in your face thing where you had, you know, the shout the abortion on one side and the fetuses on poster board on the other.

[116] And it really revolved around kind of clinics and brick and mortar physical things.

[117] But this is something different.

[118] This is far away from that.

[119] It's really harder to visualize, right?

[120] It's harder to kind of have that fight be focused around a place or doctors a clinic.

[121] I'm wondering how you think this different focus will change the fight itself.

[122] I mean, what will it look like?

[123] And what will happen next year when the Supreme Court rules on that very important case in Mississippi that will decide the fate of row which extended federal protection for abortion to begin with.

[124] Yeah, I do think that medication abortion will be the battleground where both the anti -abortion and abortion rights folks meet much more so than they have in the past.

[125] I think this will be the new frontier.

[126] More and more women will be getting abortions by pill, and that will change everything from laws to how the sides in the abortion debate can fight with each other, right?

[127] It's going to be a lot harder in some ways to kind of rally the troops on both sides because it's a much quieter type of procedure and the location is much more private.

[128] So I think, you know, the sort of very in -your -face visceral stuff may not happen as often.

[129] But I have no doubt that the temperature in the abortion debate is not going to be turned down.

[130] And just to give you, you know, one recent example, just this month when the Supreme Court was hearing the Mississippi abortion case right outside the Supreme Court, there were several women from Shout Your Abortion who weren't pregnant, but who were taking Miffipristone pills right in front of the Supreme Court.

[131] And I think we're going to see more of that kind of political theater on both sides, probably.

[132] Right.

[133] I guess, Pam, if we've learned anything over the past 40 years, it's that America always finds a way to fight about abortion, that both sides will come up with new arguments.

[134] You know, the symbolism might be different, but the fight will go on.

[135] And for many women, so will abortions, regardless of the laws and court decisions.

[136] Right.

[137] I mean, on the one hand, this is a very different landscape than before Roe v. Wade, right?

[138] We're not talking about dangerous, you know, back -alley abortions.

[139] We're talking about putting postage stamps on a package of abortion pills that a woman can receive it home and take in her own kitchen on her own time.

[140] And it's a method that is much safer than ways that women tried to accomplish abortions before it was legal.

[141] So there is a lot that has changed.

[142] But on the other hand, things may be the same in that women will still have to scramble to get an abortion, especially if Roe is rolled back, and the women who will face the biggest obstacles will still be low -income women, which has always been the case.

[143] So in a way, everything has changed and nothing has changed.

[144] Pam, thank you.

[145] Thank you.

[146] We'll be right back.

[147] Here's what else you need to know today.

[148] On Wednesday, the Federal Reserve announced a major policy shift, saying it would withdraw pandemic -era aid faster than expected, because the economy had largely recovered.

[149] The Fed said the change would help it tackle inflation by putting it in a position to raise interest rates, its most powerful tool for influencing the economy.

[150] Rates, currently near zero, are expected to rise three times next year.

[151] And COVID deaths in the U .S. surpassed 800 ,000, the highest known number of any country in the world.

[152] Older Americans made up three quarters of those deaths.

[153] One out of every hundred Americans over the age of 65 have died from COVID -19.

[154] Today's episode was produced by Luke Vanderplug and Rochelle Bonja, with help from Daniel Gimette and Claire Tennis Sketter.

[155] It was edited by Paige Cowett and engineered by Chris Wood.

[156] It contains original music by Dan Powell and Marion Lazano.

[157] Our theme music is by Jim Brumberg and Ben Landsberg of Wonderly.

[158] That's it for the Daily.

[159] I'm Sabrina Tavernisi.

[160] See you tomorrow.