Texas’s S.B. 4 exempts pregnant people from criminal penalties for ordering pills online—so unless Texas is willing to post abortion police at every woman’s mailbox to intercept her mail, Texans will still have access to medication abortion online.
After Texas enacted a six-week abortion ban on September 1, the number of Texans visiting the website of Plan C—which provides information about how to order abortion pills online—increased over 15 times what it was five months ago.
While 2,220 Texans visited the Plan C website in April of this year, a whopping 34,996 Texans visited the website last month. “Most were from Houston, Dallas, Austin, San Antonio and Fort Worth. But they were from all over, all over the state,” Plan C’s co-director Elisa Wells told Ms.
On the heels of the state’s newly-enacted abortion ban—blocked by a federal court on Oct. 6, then reinstated on Oct. 8 by the Fifth Circuit Court of Appeals—Governor Greg Abbott signed into law S.B. 4 making it a felony for doctors to mail abortion pills to a patient. Violating the law is a felony punishable by up to two years in jail and a fine of $10,000. The law applies to abortions induced after December 1, 2021. The law applies only to doctors and explicitly exempts pregnant people from criminal penalties for ordering pills online.
Unless Texas is willing to post abortion police at every woman’s mailbox to check and intercept her mail, Texans will still have access to medication abortion online and through the mail, says Wells.
“The antis are trying anything and everything they can to stop access to the medications. The good news for our model is that it’s not really going to have any effect on the supply sources that we point people to, like Aid Access and online pharmacies mailing pills to people in Texas because those are all operating outside of these regulated structures. They probably don’t have people sitting in Texas who are doing the mailing, but they are probably mailing from other states or mailing from post office boxes or fake return addresses or hidden return addresses.”
“[The new law] is not medically justified in any way,” said Wells. “We get our medications through the mail all the time. That’s how modern medical care works—you get your medicines in the mail. So there’s no reason for this law other than it’s punitive and trying to restrict access to abortion care.”
“That’s how modern medical care works—you get your medicines in the mail. So there’s no reason for this law other than it’s punitive and trying to restrict access to abortion care.”
—Elisa Wells, Plan C co-director
Currently, the FDA allows only doctors to distribute mifepristone (sold under the brand name Mifeprex), but misoprostol (sold under the brand name Cytotec) is widely available in pharmacies as a treatment for ulcers. Veterinarians also prescribe misoprostol to treat ulcers in dogs and other animals. The FDA is currently reviewing its dated restrictions on mifepristone and is likely to remove or loosen them in the near future.
Simple instructions for how to safely use these medications during the first 13 weeks of pregnancy are available online from How To Use Abortion Pill.
According to Wells, S.B. 4 is redundant at this point because of other barriers to medication abortion. Texas already has a ban on telemedicine abortion—which 18 other states also have—which requires a clinician to be in the physical presence of a patient when they prescribe abortion pills.
“Right now, it doesn’t really make any difference because there are more restrictive barriers on access in place, including an FDA restriction which says you can’t get it through a normal pharmacy and the ban on telemedicine abortion in Texas. But if those things were to somehow go away and S.B. 4 was still on the books in Texas, it would be another impediment to access.”
In addition to banning doctors from mailing abortion pills, S.B. 4 also prohibits doctors from prescribing abortion pills after seven weeks—three weeks before the current FDA limit of 10 weeks.
The Texas law is unlikely to slow the tide of abortion pills coming into the state by mail because many online pharmacies and clinics that mail pills are based outside of the state or the country, says Wells.
The Texas law is unlikely to slow the tide of abortion pills coming into the state by mail because many online pharmacies and clinics that mail pills are based outside of the state or the country.
The virtual abortion clinic Aid Access, for example, is based in Europe. Founded and run by Dr. Rebecca Gomperts from the Netherlands, Aid Access has physicians who screen patients and prescribe abortion medication for $110 —with a sliding scale fee in cases of financial need— and then send the prescriptions to a pharmacy in India, which mails them to patients in the U.S.
Because Aid Access doctors are located outside of the country, Texas cannot prosecute them.
Dr. Abigail Aiken, a professor at the LBJ School of Public Affairs at the University of Texas at Austin who studies abortion outside of formal healthcare settings, suspects more Texans are now self-managing their own abortions by ordering abortion pills online.
“First, as research shows, both cost of in-clinic services and distance to the nearest clinic are key reasons why people use self-managed abortion. Texas just increased both cost and distance by forcing people to go out of state for care,” said Aiken.
“Second, we have a window on what happened to requests to Aid Access for self-managed abortion the last time Texas banned in-clinic services at the start of the COVID pandemic,” she continued. “Requests doubled over the approximately four-week period during which clinical services were suspended.”
Texas politicians are adopting ever greater restrictions on abortion—not only S.B. 8 and S.B. 4, but in June a “trigger ban” that would immediately outlaw abortion in Texas if the Supreme Court overturns Roe v. Wade. But like the Jane Collective in Chicago in the 1960s, women have always found ways to end unwanted pregnancies, despite the law. And thanks to the internet and abortion pills, their options for doing so today are safer and easier than ever.