At the East Cypress Women’s Center, an abortion provider in Fort Lauderdale, the phones have been ringing non-stop since Friday’s Supreme Court ruling overturning Roe v. Wade.
Most of the patients calling the center want to know if they will still have access to medication abortion or the so-called abortion pills, misoprostol and mifepristone, which were approved by the Food and Drug Administration more than 20 years ago.
“People are scared,” said Leda Lanza, a medical assistant at East Cypress who has been answering the calls. “People are like, ‘Oh my God, can I still do this?’.”
The pills, which are used in the first 10 weeks of pregnancy, have become more widely available since December 2021, when the FDA lifted restrictions on where the drugs could be dispensed, allowing doctors to prescribe them online and patients to receive them by mail.
Since January, at least 20 states have proposed bills that would restrict or ban abortion pills, according to Pew Stateline. Florida is not one of them, although state law requires an in-person visit for a doctor to prescribe the medications.
The Justice Department has warned states not to restrict access to the drugs, though many expect that the abortion pills may become the next legal battleground. The pills are an example of how medical research and development can complicate or even thwart a legislature’s determined efforts to dramatically reduce the number of abortions.
Further restricting or banning access to the pills would be difficult to accomplish without compromising the doctor-patient relationship, said Kenneth Goodman, founder and director of the University of Miami Miller School of Medicine’s Institute for Bioethics and Health Policy.
“Suppose they try and outlaw pills, and somebody gets a pill in the mail. ... How would the state of Florida propose to find out if someone even got that pill without violating that person’s privacy rights,” Goodman said. “There’s no way to enforce that without violating privacy laws, which are guaranteed under Florida’s constitution.”
Even if Florida prohibited the pills, abortion access advocates say a ban would fail to prevent patients from getting them in other states or having them delivered by mail from Europe.
“Legal doesn’t mean accessible,” said Alyx Carrasquel, an intake coordinator for Florida Access Network, which funds abortions for women who cannot afford them. “Abortion funds are going to make sure people access safe abortions regardless of which state they live in.”
Florida law requires patients to meet a doctor in person at least 24 hours before taking an abortion pill, though that has not deterred their use. Nearly half of all abortions in Florida in 2019 were induced using medication, according to a report from the Centers for Disease Control and Prevention.
Nationally, medication abortions have accounted for more than half of all abortions reported in the United States since 2020, according to the Guttmacher Institute, a pro-abortion rights research and policy organization.
Demand for abortion pills is expected to rise in the wake of the Supreme Court’s decision on abortion, and opponents of the Supreme Court’s ruling have been working to spread the word that there are many ways to get them.
Amy Merrill is a co-founder of Plan C Pills, a nonprofit that provides information on how people can access abortion pills in all 50 states, including those that restrict their access. She said the drugs allow people who don’t have access to an abortion clinic nearby to end their pregnancy at home.
“These pills need to be in the hands of people who need them,” Merrill said. “Nobody should be criminalized for seeking care.”
For people seeking abortion pills in Florida, Plan C refers them to a group called Aid Access, a nonprofit group that connects patients to doctors in Europe who can provide abortion medications by mail, though delivery takes weeks instead of days.
The process of medication abortion consists of taking two drugs over 48 hours: mifepristone, which ends the pregnancy, and misoprostol, which causes cramping and bleeding to empty the uterus.
Most visits to East Cypress begin with a medical examination to determine the stage of gestation and to provide counseling if necessary, Lanza said.
Patients approved for the medication take the first pill in the doctor’s presence, she said. After completing the first course, the patient is sent home with an envelope containing four more pills, which are to be taken 24 hours later — all at once and on an empty stomach, Lanza said.
“The first four to six hours once the pills dissolve is when they have a miscarriage at home,” she said.
Patients are asked to return for a follow-up visit two weeks later, she said, when the doctor performs an ultrasound to ensure the pregnancy has terminated. If the pregnancy has not ended, Lanza said, then the doctor will perform a surgical abortion — although that option could be foreclosed if the Florida Legislature follows the lead of some other states and imposes a blanket ban, effectively putting clinics out of business.
This coming Friday, a law passed during the recent legislative session takes effect that reduces the window for having an abortion from 24 weeks into a pregnancy to 15 weeks. Although they largely cheered the court’s ruling, Florida Republican lawmakers, the majority in both chambers, have said little about whether and how they might further restrict or outlaw abortions entirely. Polls show a majority of Americans oppose banning abortion, although it’s not clear how big a motivating factor that might be during November’s midterms.
The Herald reached out to two Florida senators and multiple GOP representatives on what the party’s path forward might be on abortion pills without success.
As it is, surgical abortions are not an option for many in the United States, where nine out of 10 counties do not have a clinic, according to the Guttmacher Institute, whose data also shows that the number of abortion clinics in Florida declined from 2014 to 2017.
For Plan C’s Merrill, the reduction in abortion clinics is a big reason why she created a group to share information about the pills.
“People have been jumping through hoops to get care,” she said.