Americans can access abortion pills by mail, but states could limit access if Roe v. Wade is overturned.
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A leaked draft opinion suggests the Supreme Court may overturn Roe v. Wade, the historic 1973 decision that made abortion legal nationwide, according to Politico. The news has many wondering what that could mean for access to abortion pills, which are currently used for more than half of U.S. abortions. While the future of abortion access remains unclear, here's what you need to know about access to, and using abortion pills right now. (Related: How Late In Pregnancy Can You Actually Have an Abortion?)

In December 2021, the Food and Drug Administration (FDA) announced that it would permanently allow Americans to access abortion pills by mail. Since the ruling, patients have been able to receive FDA-approved abortion medication, which was initially only available through in-person pick-up, by mail. However, some states have laws in place that prevent their residents from receiving abortion pills by mail, regardless of the FDA's decision. Nineteen states currently have prohibitions that ban the use of telemedicine for abortion, and residents of states that aim to ban all abortion methods if Roe v. Wade is overturned would not be able to have telemedicine abortion consultations in their state, according to The New York Times.

For many people, the FDA's ruling meant easier access to Mifeprex (mifepristone), a pill used in tandem with another medication called misoprostol, to terminate an early pregnancy through 70 days or 10 weeks of gestation (i.e. when it's been 70 days or less since the first day of the last menstrual period). The two-part process is safe and effective when prescribed by a qualified healthcare provider, according to the FDA. A study published in Obstetrics & Gynecology comparing the safety of medication abortion through telemedicine and in-person abortion found that the rate of complication was the same (under one percent). To put it into perspective, the FDA notes that of the roughly 4 million patients who have used these medications to induce abortion since 2000, there have been 26 associated deaths as of June 2021.

While the FDA approved Mifeprex in 2016, patients were required to pick up the medication in person until July 2020, when the FDA lifted the requirement due to the pandemic. In the December 2021 update, the FDA announced that the change would remain in place, even after the pandemic is over. The pills still require a prescription, but the FDA allows for mifepristone and misoprostol to be prescribed via a telehealth visit before being delivered by mail.

Though this ruling has helped expand access to abortion for plenty of Americans, abortion laws in the U.S. are currently in question. Roe v. Wade has been on shaky ground since former president Donald Trump appointed three conservative Supreme Court justices during his presidency and vowed they would reverse Roe v. Wade. (Related: TikTok Activists Are Fighting Back Against the Extreme Texas Abortion Law)

If Roe v. Wade is overturned, it would leave it up to states to decide the legality of abortion, which could create a domino effect. Thirteen states have passed "trigger laws" that would ban abortion "immediately or very quickly," if Roe v. Wade is overturned, according to The New York Times. Additionally, seven states have laws intended to restrict the right to legal abortion "to the maximum extent permitted" by the Supreme Court if Roe v. Wade no longer stands, reports the Guttmacher Institute.

Although states would be given more power to decide who has access to abortions if Roe v. Wade is overturned, some experts are confident that the FDA ruling on abortion pill access will remain intact. "Because the FDA has approved abortion pills as safe and effective and set forth a regimen by which they have to be dispensed, states are not allowed to do anything different, because federal law pre-empts or is supreme over state law," David Cohen, an expert in gender and constitutional law at Drexel University's law school, told The New York Times. However, others predict the shift could lead to many legal conflicts, The Times reports.

It's also worth noting that abortion pills can only be used up to 10 weeks into a pregnancy, which is still too early for plenty of people, particularly those with irregular periods or those who experience birth control failure, to realize they're pregnant, according to current FDA guidance. The fight for abortion access remains in limbo, especially in states with lawmakers set on prohibiting abortion access in any way possible. And given that an estimated 1 in 4 U.S. women will have an abortion by age 45, safe access is critical.