The leaked draft of a ruling that would overturn Roe v. Wade was published by Politico at 8:32 p.m. ET on Monday. Online searches for “abortion pills” shot up immediately.
If abortions become illegal, medication abortion would be one alternative. And it is one place where the next battles over abortion will take place.
The number of Google searches for abortion pills reached an all-time high on Thursday.
Mary Ziegler, a visiting law professor at Harvard Law School who is an expert on the law, history and politics of reproduction, said that access to abortion will be decided over medication abortion. The country could face a conflict between the FDA, taking a position that the drugs are safe and effective, and states trying to criminalize them.
“There’s a lot of uncertainty essentially in how this is going to work,” said Ziegler, who will be taking a position as a professor of law at UC Davis School of Law.
Search Interest for 'Abortion Pill' Was Highest in These Nine States and DC
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Among the top 10 states with the highest interest in "abortion pill" searches were two states where abortion bans would come into effect if Roe v. Wade were to fall — Louisiana and Mississippi.
The other states with the most searches were Nebraska, Iowa, Georgia, Mississippi, Delaware, Maryland, Kansas and Michigan plus the District of Columbia.
But mostly Republican lawmakers are trying to limit medication abortions, too. Legislatures in 16 states have also proposed bans or restrictions on such abortions, reports the Guttmacher Institute, a research group that is in favor of abortion rights. Those include Arkansas, Kentucky, Ohio, Oklahoma, Tennessee and Texas.
Thirty-two states require that medication abortions be prescribed by physicians. (Other medications can often be prescribed by physician assistants.) Nineteen states say a medical clinician needs to be present when a patient receives the pills. And three states — Arizona, Arkansas and Texas — ban mailing abortion pills to patients.
High-Interest Queries Containing 'Abortion Pill' Shed Light on Search Intent
The Google searches give a glimpse of people's concerns about the availability of abortions. The following queries grew at a rate of 5,000% or more over the week that was sampled, hinting that some people might be considering stockpiling the pills:
- “Do abortion pills expire?”
- “Shelf life of abortion pills”
- “Abortion pill shelf life”
- “Buy abortion pill kit online amazon"
Other searches were for "Plan B," an emergency contraception. They showed the same rate of growth.
Where Will Abortion Pills Stand if Roe vs. Wade Falls?
More than half of the abortions in the United States, 54%, now take place with pills, according to a Guttmacher Institute report released in February. That’s a rise from 44% in 2019. The trend had already been increasing but shot up during the pandemic when the use of telemedicine also rose.
As of last year, the Food and Drug Administration has allowed mail delivery across the country. Until then, women were required to pick up abortion pills in person. A scientific review found that complications were rare and that of the 26 deaths associated with the drug since 2000, not all could be directly attributed to it, the FDA reported.
Medication abortions involve a combination of two drugs — mifepristone, approved by the Food and Drug Administration in 2000 and which blocks a hormone needed for pregnancy, followed one or two days later by misoprostol, which causes cramping that empties the womb. Medication abortions are approved for the first 10 weeks of pregnancy, although some health care providers offer the drug combination in the second trimester in what is known as off-label use.
Greer Donley, an assistant professor at the University of Pittsburgh Law School, said that theoretically the FDA loosening its restrictions on mifepristone would not have an effect in states that continue to impose restrictions such as in-person dispensing, or that ban abortion if Roe v. Wade is overturned.
But advocates like her question whether states can actually regulate medication abortion beyond the FDA, or ban it all together, because federal law trumps state law.
"So in conflicts between the two, federal law wins," Donley said. "We can expect courts to be asked to evaluate the limits of FDA’s power to be the sole regulator of mifepristone in the future."
The battleground is also more practical, she said.
Abortion pills are available online from providers in the United States and internationally, where abortion may be legal and protected. Mail moves in and out of states without oversight, meaning that practically, it would be very hard to identify and track medication abortion.
Aid Access, for example, was started in April 2018 by a Dutch doctor. Based in Europe, the group’s physicians prescribe abortion medication, sometimes for free in cases of financial need, and then send the prescriptions to a pharmacy in India, which mails them to the U.S. Aid Access is managed by a physician, Dr. Rebecca Gomperts.
"And though antiabortion states would love to be able to stop Aid Access, it is an international organization over which they have no control," Donley said.
"Abortion medication poses an existential threat to the antiabortion movement’s ability to enforce abortion bans," she said.
States are going to struggle if they are committed, as some have said they are, to not punishing women who do have abortions.
“It’s a problem if you want to have an enforceable abortion law that people can get pills on the internet from other countries,” Ziegler said.
Going forward, she said the country would see more states trying to regulate what other states are doing, setting up legal conflicts that might ultimately end up back at the U.S. Supreme Court.
A Breakdown of the Data We Reference
Google Trends is a tool that shows anonymized, categorized and aggregated search data. The tool provides a zoomed-out view of what topics people are searching for and at what velocity. The data cited in this article is valuable on the storytelling level, but the anonymity and normalization of the data make raw numbers for full analysis inaccessible.
In this article, we analyze search trends surrounding queries that contain or are related to the phrase “abortion pill” from 3:00 pm ET on April 28, 2022, to 2:00 pm ET on May 5, 2022. The state-by-state comparison of search interest is measured by the percentage of searches within the state that contained or were related to “abortion pill.” The top queries that contain “abortion pill” were measured by growth rate in the number of searches over the time period.
