Finally, some modest good news for abortion rights in America
The Biden administration made two moves to protect medication abortion
There have been so few victories for the pro-choice movement over the past year that women’s rights advocates can be forgiven for taking pleasure in two moves that the Biden administration made this week.
The first, from the Department of Justice (DoJ), was a statement meant to push back against a legal absurdity that is gaining popularity on the anti-choice right: the idea that the 1873 Comstock Act, an archaic anti-obscenity law, prohibits the sending of abortion medication through the mail. The second was a move by the Food and Drug Administration (FDA) to allow mifepristone, one of the two drugs used in medication abortions, to be distributed at retail pharmacies, rather than exclusively from doctors.
Neither move by the Biden administration is likely to significantly improve abortion access, especially not for the millions of women living in the 13 states that have banned abortion outright, or the five that have severely limited the procedure, since the US supreme court overturned Roe v Wade last summer in Dobbs v Jackson Women’s Health. But the rule changes show a new willingness by the Biden administration to make at least some tepid and belated efforts to expand women’s rights as the crises created by Dobbs continue to worsen.
The FDA’s move, frankly, is especially overdue. Since mifepristone, a medication that blocks the pregnancy hormone progesterone, was finally approved by the agency for use in America in 2000 (it had been in use in Europe since the 1980s), the drug has been subject to intense, labyrinthine and medically unnecessary bureaucratic restrictions.
For years, doctors who want to provide abortions have had to stock mifepristone themselves. Unlike other drugs – including misoprostol, the other medication used in abortions – it had to be given out directly by the prescribing physician. Until the pandemic, the pill had to be administered by abortion providers in person, and could not be distributed remotely – a rule that was temporarily suspended during coronavirus lockdowns, and quietly lifted permanently by the FDA in December 2021. The new rule will allow mifepristone to be distributed by regular pharmacies, with a regular prescription.
But the FDA’s new guidance still maintains distinctions around mifepristone that mark it as distinct from other medications – distinctions that have nothing to do with the safety or efficacy of the drug, which have long been proven, and everything to do with the politics and stigma surrounding abortion. Some restrictions have been left in place.
Not all healthcare providers, for instance, can prescribe mifepristone: those that do must first prove to agency satisfaction that they are competent to perform abortions. Patients, too, must still sign a consent form, something not required of other medicines. And there are new obligations for the pharmacies that want to distribute the drug. Each pharmacy must appoint and train a compliance officer who is in charge of ensuring that all the rules surrounding mifepristone are followed, for example; steps must be taken to conceal the names of prescribing doctors, including from internal company databases, to protect them from violence and harassment.
The move does seem likely to marginally expand access to abortion pills, at least in Democratic-led states. On Thursday, CVS and Walgreens indicated that they would begin distributing mifepristone. The change is a small and important step toward removing the needless and bigoted bureaucratic obstacles that both stigmatize abortion care and place it out of reach, and towards placing these medications where they belong: over the counter.
But it’s still unclear how the FDA rule change will affect the biggest battles over medication abortion – the ones playing out in the courts. Since the Dobbs decision, demand for the pills has exploded, and a growing number of abortion providers have set up online operations – based both overseas and in the more robustly protective Democratic states – that send abortion medications through the mail.
These prescribers have opened a new era of abortion access in which abortion pills have become widely available even in states with strict bans, and women with internet connections, mailing addresses and a little bit of experience in covering up their digital tracks have found themselves able to terminate unwanted pregnancies safely, even in defiance of misogynist local laws. The anti-choice movement has succeeded in shuttering clinics across the south and midwest, but they haven’t managed to shut down the internet.
Enter the Comstock Act, a long-obscure federal law which has enjoyed a revival in anti-choice legal thinking since Dobbs. Passed in 1878, in the midst of a misogynist moral panic, the Comstock Act prohibits the mailing of “obscene” materials, including any “article or thing designed, adapted, or intended for producing abortion”. The first arrests under the act were meant to suppress the distribution of a feminist pro-contraception tract.
The act has been largely defunct since the establishment of a right to contraception – and a right to privacy – in the 1965 supreme court ruling in Griswold v Connecticut. Recently, however, anti-choice forces have argued in court – repeatedly and aggressively – that since Roe has been overruled, Comstock applies, and sending abortion pills through the mail is once again illegal.
On Tuesday, the DoJ disagreed, publishing a legal memo arguing that the drugs can be legally sent through the mail, including to states with abortion bans – that is, so long as the sender believes that the recipient will use them in accordance with local law. The DoJ opinion clears the US Postal Service to keep delivering the packages – and provides a bit of legal cover and plausible deniability to those who send abortion medications into conservative states.
Will it hold up in court? Who knows. The memo issues one interpretation of current law, but the federal courts, packed with conservative ideologues and mealy-mouthed centrists who view hostility to women’s rights as a marker of their seriousness, might disagree.
Still, the moves are encouraging signs from the Biden administration, whose response to Dobbs, and to the mounting civil rights and public health crises that it has unleashed, has tended to vacillate between incompetence, indifference and outright contempt. The Democratic party has long treated the left, and feminism in particular, as an annoying younger sibling that it needs to keep in line.
But the midterms should have broken this spell: the Democrats performed much better than expected, and abortion was a big part of why. The elections should put to bed forever the dusty centrist conventional wisdom that support for abortion rights is electorally damaging to the Democrats – quite the opposite has proved to be the case. Hopefully, the Biden administration is listening.
Moira Donegan is a Guardian US columnist
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Source: US Politics - theguardian.com