/Lawmakers will be hard pressed to ban medication abortion, advocates say

Lawmakers will be hard pressed to ban medication abortion, advocates say

Mississippi law prohibits the use telehealth to prescribing medication. Dr. Rebecca Gomperts is the founder of Aid Access. She is located in Austria and writes prescriptions for Mississippians. She then sends her prescription to an Indian pharmacist who will mail the pills to a Biloxi or Belzoni address. Online pharmacies are also available for purchase. The anti-abortion legislators have pledged to clamp down on cross-border transactions that bring the medication to the country, which has only one abortion clinic. They will face fierce opposition from local activists, who are allied with pharmacies and prescribers all over the globe. Michelle Colon, executive Director of SHERo Mississippi (a non-profit that promotes leadership among Black women in Mississippi), said, “With all the medical technology we now, it’s absurd for the antis [anti-abortion activists] to think we’re not going to do it. “We will do it right under them, and they won’t be able or they will know it. More than half of the patients at Jackson Women’s Health Organization in Mississippi get medication abortions. Mississippi law requires that they take the first pill, misoprostol, at the clinic. This stops the pregnancy growing. READ MORE: Mississippi Abortion – Our full coverage. The second set of pills, misoprostol opens the cervix, triggers bleeding and cramping to end the pregnancy. This looks almost like a miscarriage. In 2000, the U.S. Food and Drug Administration approved these pills. The federal government approved telemedicine prescriptions of the drug in December 2000. However, Mississippi and other states have banned this practice. Mississippians can still buy the pills without going through the traditional medical system. A 2020 study looked at more than 6,000 U.S. residents who requested abortion pills via an online telemedicine provider in 2017 and 2018. The study found that Mississippians asked for the pills more often than anyone else in the country. This is likely due to the difficulties in accessing abortion via in-state providers. If Roe is overturned by the Supreme Court, the state’s trigger law of 2007 will take effect. It bans abortion in all cases except rape or when the mother’s safety is at risk. It does not distinguish between different types, so it will ban both surgical and medication abortions. However, lawmakers believe that additional measures are needed to combat the use of pills. Senator Joey Fillingane (R-Sumrall) has written numerous restrictions on abortion. He suggested that a separate law on medication abortion could direct law enforcement to address the issue. The Legislature could also provide funding for that work. “We are aware that this is a new level of law enforcement we will be expecting you to perform in the agency, attorney General’s office, or to whomever it applies to. Fillingane stated that you will need more staff and more resources to enforce the new law. Fillingane said that a law banning abortion drugs could be enforced by filing lawsuits against those, organizations, and manufacturers who have sent prohibited medication into Mississippi. Mississippi’s reproductive rights activists aren’t sure how this could work, given the fact that so many of the providers and pharmacies are located abroad. Laurie Bertram Roberts is the cofounder of the Mississippi Reproductive Freedom Fund. She also serves as the executive director of the Alabama-based Yellowhammer Fund. “Arkansas? He will just, like, go over there in his seersucker costume and demand that these people are prosecuted. He won’t go to Austria to impress anyone or round up Rebecca Gomperts. India is not going to be impressed with Joey Fillingane. Let him come over and round up people and jail them.” The past shows that Mississippi will not allow Gomperts, an abortion rights advocate, to change his mind. In 2019, the FDA warned Aid Access that it must stop selling “misbranded, unapproved new drugs” in America. This was because the brands Aid Access uses for its patients aren’t FDA-approved. The site has been maintained by Gomperts. The organization works with pharmacies based in India because generics produced in the country are high quality and government-supervised, she has said. She believes strict regulation of abortion medication is based on politics. Research has shown that medication abortion is safe. The FDA recorded 22 deaths in people who used mifepristone between 2000 and 2017, an average rate of one in 155,000. This compares to a maternal death rate of 17 per 100,000 in 2018. A February study in the Lancet revealed that only 1% of women who used Aid Access to terminate a pregnancy required medical treatment. This is a higher than what was recorded in clinical settings but still considered rare by researchers. Christie Pitney, a certified midwife and a U.S.-based clinician with Aid Access, is listed as Christie Pitney. She and her colleagues provide telemedicine services to patients in legal states, while Gomperts prescribes for patients in countries where it is prohibited. Pitney stated that Aid Access will continue to operate despite the existence of state laws. She stated that Aid Access and her attorney believe there is no state jurisdiction to stop Dr. Gomperts from providing these services. “So it will continue to be available to Mississippi, except they get rid of the federal crime of opening someone else’s mail. We’ll still be there until they reach that level.” The law in this area is complex and murky. Legal questions arise if a California provider was following California laws while prescribing medication abortion to a Mississippi patient. How would a state enforce a judgment against an overseas provider if it won a lawsuit? Elizabeth Sepper, a University of Texas law professor and expert in health law, stated that “they don’t keep any money in Mississippi.” “Aid Access doesn’t have a bank account from which the state can access to recover the judgment. It may not have any effect on Aid Access. Fillingane stated that Mississippi could enforce laws prohibiting abortion medication in the same way as other drug laws. There is no precedent for states criminalizing or banning drugs that have been FDA-approved and are widely used in the United States. Because the FDA is responsible for overseeing the distribution of pharmaceuticals across the country, the FDA sent a warning letter to Aid Access. Laurie Sobel, associate director of women’s health policy at KFF (a non-profit focused on health policy research), said that “We’re stuck in a huge, huge, gray area and nobody knows how it will end.” A Mississippi lawsuit is a case in point. GenBioPro, a manufacturer of generic mifepristone in 2020, sued Dr. Thomas Dobbs, the State Health Officer, and the Health Department, claiming that the state’s strict regulations are inconsistent with the FDA’s. Mississippi law treats abortion pills in many ways like other types of abortion. Patients must undergo counseling and an ultrasound before they can receive mifepristone at a clinic. However, the FDA allows more doctors to prescribe mifepristone, and patients can take it at home. GenBioPro claims that it is against the Constitution for states to regulate FDA approved substances more stringently that federal authorities. The commerce clause in the U.S. Constitution gives the federal government explicit authority to regulate interstate commerce and prohibits states from passing laws that burden this commerce. Federal law overturned a Massachusetts ban on Zohydro (a controversial, but FDA-approved, opioid). Mississippi Today spoke with legal experts who said that there is very little case law in this field. Advocates and lawyers believe that it will be easier for states to enforce the ban on medication abortions and bring criminal charges against people within their borders, regardless of how preemption arguments turn out. This could include friends and relatives who give abortion medication to a pregnant woman, or pregnant women in states that criminalize self managed abortions. Pitney stated that Aid Access understands that patients in Mississippi, such as Mississippi, will be at greater risk if Roe becomes invalid. If/When/How provides legal assistance to patients. The Mississippi trigger law prohibiting abortion in most cases stipulates that it cannot be used to prosecute women for ending their own pregnancy. However, anyone who “knowingly or recklessly” performs or attempts or induces an abortion in Mississippi can face a maximum of 10 years imprisonment. A law prohibiting the “killing an unborn baby” is also in place. It applies from conception. Although it does not apply to all lawful abortions, it can be used to prosecute attempts at ending a pregnancy. There is no exception to this law protecting pregnant people from such prosecution. Because of the technological advancements that made medication abortion legal, post-Roe criminalized abortions are now safer than before 1973. However, these technological advances could also lead to increased scrutiny by the state if police or prosecutors are strict in enforcing abortion bans. Elizabeth Sepper, a law professor and expert in health care at the University of Texas said that everyone carries tiny computers around with them. “States will likely engage in electronic surveillance to figure out who is most likely to distribute these particular pills, track them, and determine who they are communicating with,” Sepper, law professor and health care expert at the University of Texas, said. Such surveillance has been used in Mississippi’s pregnancy outcomes cases. Latice Fisher was charged with second-degree murder in Oktibbeha County after she gave birth to a stillborn baby. Prosecutors searched her phone data for the words “buy abortion pills” and found it. This search was used to determine motive and suggest that the pills could have had an effect on her pregnancy and delivery. The charges were dropped after reproductive rights advocates intervened. Advocates fear that anyone who comes to the hospital with miscarriage complications could be subject to intrusive questioning by police and hospital staff in order determine if a crime was committed. They could also be subject to internet searches. “What I believe we will see more is that pregnancy loss, which is incredibly common,… will be subjected to policing and surveillance, questioning and intrusive, really dangerous conversations with law enforcement and health care providers, because oftentimes miscarriages or self-managed abortions appear identically or are indistinguishable form a medical perspective,” Dana Sussman (acting executive director of National Advocates for Pregnant Women), who worked on Fisher’s case. Local prosecutors may choose to conduct investigations and charge differently. This could mean that pregnant women in Mississippi could be subject to more scrutiny, based on their location. Sussman stated that it was remarkable how much power and discretion local prosecutors possess. Mississippi abortion rights advocates care less about the availability and criminalization of pills, and are more concerned about people who use them. This includes people who lose a pregnancy naturally and who are treated as criminals. Even if Mississippi does not pass any new restrictions on abortion beyond the trigger ban’s, local anti-abortion prosecutors may be able to justify serious charges against those who believe that an abortion occurred or was attempted. Colon stated that black and brown women are at greatest risk of being criminalized and punished. Fillingane said that he doesn’t support legislation that would punish or fine people who use the pills. Fillingane also said that he doesn’t see Mississippi law enforcement taking extreme measures to find people with the pills. He said, “I don’t see that happening in the normal scope and course of things as law enforcement mechanism.” I think you should cut it at the source. It’s easier to enforce and more effective to enforce. Advocates disagree. However, regardless of the steps taken by lawmakers or prosecutors, they will not stop access to abortion medication within state borders. Colon stated that there will not be coat hangers nor bleach drinking. Colon said that medical abortion was safe. “I’m not quiet about it.” To support this important work, make a regular donation to the Spring Membership Drive today.