On Tuesday, South Dakota Gov. Kristi Noem signed an executive order banning clinicians from prescribing medication abortions through telemedicine, the latest in a wave of red states trying to restrict access amid the growing threat to Roe v. Wade.
In her executive order, the Republican governor declared that abortion pills might only be prescribed or dispensed by a licensed doctor in South Dakota after an in-person examination. The order also blocks physicians and manufacturers from providing abortion-inducing medication via courier, delivery, telemedicine, or mail service.
According to the order, abortion-inducing medications are also no longer allowed to be provided in school or on state grounds. This also directs the South Dakota Department of Health to develop licensing requirements for “pill-only” abortion clinics. The department will also need to collect data on how often medication abortions are performed as a percentage of all abortions and enhance reporting requirements on emergency room complications supposedly related to medication abortions.
Medication abortion, known as the “abortion pill,” has been available in the U.S. since 2000, when the Food and Drug Administration approved using mifepristone for early nonsurgical abortion. Pregnant people typically get a medication abortion by taking a combination of mifepristone and misoprostol ― usually spaced 24 hours apart ― which essentially induces a miscarriage.
Mifepristone is approved for use at up to 10 weeks of gestational age, though it is used safely off-label at later stages. The drug blocks progesterone receptors that are necessary to maintain a pregnancy. Medication abortion is successful 93% to 96% of the time, according to Planned Parenthood.
The drug is prevalent. Medication abortions increased from 5% of all abortions in 2001 to 39% in 2017, even while the overall number of abortions declined, according to The Guttmacher Institute, a pro-choice research organization. The method allows abortion seekers to terminate their pregnancies safely and effectively in the privacy of their own homes, provided they are in the early stage of pregnancy.
Contrary to Noem’s order, clinical evidence overwhelmingly shows that medication abortion is very safe. A 2019 study found that people who received medication abortion doses by mail had similar outcomes as those who received an abortion at a physician’s office and reported high satisfaction levels with the service. Telemedicine for medication abortion has been critical in areas where people often have to travel more than 100 miles to access an abortion, making it the safest option for rural and low-income pregnant people.
The FDA announced in April that pregnant people would be able to get prescribed a medication abortion through telemedicine after President Joe Biden lifted the previous administration’s restrictions on telemedicine abortion ― something doctors have been fighting for long before the pandemic ― due to the unnecessary COVID-19 risk of physically going into a health clinic for a medication abortion.
“The past 20 years have given us just a glimpse of the transformative potential of medication abortion. Even before the COVID-19 pandemic, medication abortion use was rapidly increasing. In fact, in just the last decade or so, the number of clinician-managed abortions using medication increased 73%,” Guttmacher spokesperson Joerg Dreweke told HuffPost.
“Beyond its exceptionally safe and effective track record, what makes medication abortion so significant is how convenient and private it can be ― and how radically it could expand access to abortion care if freed from politically motivated restrictions,” Dreweke added. “Of course, that’s exactly why anti-abortion policymakers and activists want to keep it out of the hands of people who want it.”
Courts have declared outright banning the option unconstitutional, but other state-level restrictions like Noem’s order have gone into effect without legal challenges. According to The Guttmacher Institute, South Dakota is one of 19 states prohibiting the use of telemedicine to prescribe medication for abortion, and 32 states require clinicians who administer the abortion pill to be physicians.
South Dakota’s order came about a week after Texas’ anti-abortion law was enacted. That law bans abortions after six weeks ― when most people are unaware they’re pregnant ― and relies on private citizens to enforce it by giving bounties of up to $10,000 for successfully suing anyone accused of “aiding and abetting” abortion seekers in Texas.
Within a day of the law’s effect, six other states said they wanted to adopt a similar ban. North Dakota, Mississippi, Indiana, Florida, Arkansas, and South Dakota agreed to follow Texas. Noem’s executive order on Tuesday brings her state one step closer to that reality.
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