Days before the U.S. Supreme Court cleared the way to effectively end abortion in the state, a truck rolled through parts of west Texas bearing a billboard with a message in English and Spanish: “Missed period? There’s a pill for that.”
Behind its three-day journey through college campuses was a national nonprofit called Plan C, whose mission is to increase access to abortion pills and information on how to get and use them. While Plan C says such guidance is needed more than ever in Texas now that the state has banned most abortions after six weeks, pregnant Texans soon will face another hurdle: The state is about to ban medication abortions.
“We absolutely expect to see an increase in inquiries to our website in Texas,” as well as more requests for abortion pills from other sites that sell them, said Plan C co-founder Elisa Wells.
The Texas law takes effect amid major shifts in American abortion care: Rather than a procedure, patients are increasingly choosing mifepristone and misoprostol, approved by the U.S. Food and Drug Administration for up to 10 weeks into a pregnancy.
The COVID-19 pandemic and its dramatic rise in telemedicine has accelerated the move toward “medication abortions” via virtual visits, so the patient never has to leave home. “The standard of care with respect to abortion care changed almost overnight because of the pandemic,” Wells said.
In recent months, a handful of services have cropped up to offer tele-abortions, including Hey Jane and Abortion on Demand, which works in 20 states. Nonprofits such as Just the Pill have also launched.
But they can’t work in Texas or states with similar laws: 19 ban telemedicine abortions, and Texas lawmakers have gone one step further and explicitly prohibited providers from mailing pills. The latter bill, passed by the legislature earlier this week, is on the desk of Gov. Greg Abbott.
Texan patients seeking to avoid the new laws’ restrictions could cross state lines for clinic-based care — or simply get to a state where remote abortions are allowed.
On Friday, Logan Green, the chief executive officer of Lyft, said the ride-sharing company would fully cover legal fees for any of its drivers sued under Texas’ new law. Green urged other companies to join its efforts; soon after, Uber followed with a similar promise.
Hey Jane, a startup virtual clinic, offers abortion support including remote medical visits and overnight delivery of medications. It’s racing to get up and running in New Mexico and Colorado to serve Texan patients in those states, co-founder Kiki Freedman said.
“The way telemedicine laws work, it’s based off the patient’s physical location,” she said. So patients would just need to travel to those states — ideally with help on transport, food and lodging — and once there, “talk with the provider through digital channels, get the medications and take them.”
For years, telemedicine abortion was hampered by legal issues, Freedman said, but federal regulators under the Biden administration have been supportive. And the permissions granted only for the pandemic could become permanent.
“The more hostile states are only getting more hostile,” she said, so it has long been clear that “setting up operations in adjacent states would be really important.”
Efforts in the rural Midwest could presage what happens near Texas. Just The Pill, a Minnesota nonprofit that aims to increase abortion access in rural areas, also serves patients from bordering states.
If South Dakota patients live too far from a clinic that provides abortions in Fargo or can’t wait for an appointment there, they will often cross into Minnesota, said Just The Pill medical director Julie Amaon.
They come “once to have their telehealth visit with one of our doctors (the patient must be inside state lines to comply with state laws),” she said in an email. “And then they will return two days later to pick up their medications.”
The Minnesota nonprofit has been “shocked to see requests from patients willing to fly or drive from Texas to Minnesota to access medication abortion,” she said, but Just The Pill at this point isn’t treating those patients.
It is, however, considering a plan to set up mobile clinics on the border with states that pass laws like the Texas ban, so patients would be able to see a doctor in person and get the medications in just one trip. “We want to remove as many burdens as possible for patients,” Amaon said.
Other patients may resort to alternative — and legally risky — ways to get the pills.
Plan C informs its website’s visitors about telehealth abortions but also options with potentially shakier legal foundations, including an international telehealth service called Aid Access and online pharmacies that will send abortion pills to U.S. customers from abroad. The site includes a category of “creative options,” including setting up a mailbox in a state that allows remote abortions and giving that address to a medical provider. It also offers a legal helpline so patients can assess the risks of various options.
Other issues remain, Plan C co-founder Wells said, including out-of-pocket costs that even for telemedicine abortions can run into hundreds of dollars.
Despite the jolt of the Texas ban, Wells noted that much has changed since the whisper networks that guided would-be patients in the U.S. before the Supreme Court’s Roe v. Wade decision in 1973.
“If you have a cellphone,” she said, “you have abortion access in your pocket.”