IPM: State of medication abortion access across the country

TO: Interested Parties 

FROM: Planned Parenthood Federation of America & Planned Parenthood Action Fund

DATE: February 23, 2023

RE: State of medication abortion access across the country 

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Last year, a group of anti-abortion activists and organizations filed suit challenging the FDA over its approval of mifepristone, one of two medications most commonly used in medication abortion in the United States. In the coming weeks, a Texas judge is expected to issue a ruling in the case, Alliance for Hippocratic Medicine et al v. U.S. Food and Drug Administration et al, which could force the FDA to rescind its approval of mifepristone from more than 20 years ago and remove it from the market. 

This would result in a devastating nationwide ban on mifepristone — even in states where abortion is protected — and compromise access to medication abortion across the country. Medication abortion accounts for more than half of all abortions in the United States. 

But no matter the judge’s ruling, access to medication abortion has already been severely limited. Not satisfied with the overturning of Roe v. Wade, state lawmakers opposed to abortion, including those in the states where abortion is fully banned, have continued their attacks on medication abortion during the 2023 state legislative session. 

Right now, bans have eliminated some or all access to both procedural and medication abortion in 18 states: Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Kentucky, Louisiana, Missouri, Mississippi, North Carolina, Oklahoma, South Dakota, Tennessee, Texas, Utah, Wisconsin, and West Virginia. In addition to these 18 states that have broad abortion bans in place, four more states have laws that specifically limit the provision of medication abortion via telemedicine, including Indiana, Nebraska, North Dakota, and South Carolina. States with access to abortion, and those that have banned abortion, are responding in a number of ways that will shape the medication abortion access landscape regardless of the forthcoming decision. 

So far this session, 10 states have introduced bills restricting access to medication abortion — many in states where abortion is already fully banned. 

• Iowa: State politicians introduced a ban on medication abortion, which accounts for 79% of abortions in Iowa. The proposed ban would make it a felony to manufacture, distribute, prescribe, dispense, sell, or transfer medication abortion pills in the state with penalties of up to 10 years in prison or a fine of up to $13,660. Abortion is currently still legal in Iowa.
• Wyoming: Lawmakers are considering a bill to criminalize the manufacturing, distribution, or prescribing of medication abortion — including misoprostol, which is also used for non-abortion care, including miscarriage management. There is also a penalty for providers who violate the ban. 
• Missouri: Legislation to ban the export, delivery, manufacture, and prescription of medication abortion has been introduced. This bill would also ban wholesale drug distributors from delivering medication abortion directly to patients. The legislation would also define “trafficking” medication abortion pills as a Class B felony and prohibit state pharmacists from delivering these pills to patients via mail.
• Texas: A bill that would allow pharmacists to refuse to dispense abortifacients or emergency contraceptives is under consideration. 
• West Virginia: Several bills attacking medication abortion have been introduced, including legislation to prohibit mail order pharmacies from dispensing abortion pills and a bill to fine providers who attempt to provide medication abortion via telemedicine. 
• Colorado, New Hampshire, and West Virginia: Bills that would require providers to share medically inaccurate information on medication abortion “reversal” have been introduced in each state.

On the proactive front, California lawmakers introduced legislation to ensure continued  Medi-Cal coverage for abortion medication by updating coverage requirements to align with the  most up-to-date clinical guidelines. In New York and Connecticut, lawmakers are considering legislation to direct health centers on college and university campuses to make medication abortion available onsite. And in Indiana, a bill to repeal the gestational age limit on medication abortions has been introduced.

If you plan to cover medication abortion restriction moving at the state level or the current federal case that could result in a ban on mifepristone, please reach out to [email protected].