How does the Supreme Court’s Roe v. Wade decision affect abortion pills?

A woman prepares the pills that she will take to induce an abortion in Venezuela on Jan. 2, 2021. Medication abortions are considered as safe as surgical abortions administered by a doctor in a clinic.MERIDITH KOHUT/NYT

The Supreme Court decided on Friday to end constitutional protection of abortion, a move expected to spur abortion bans in roughly half of US states.

The move is likely to restrict access to abortions at a time when abortion pills, as they are called, just became easier for some people to obtain. In certain states, including Massachusetts, residents can get pills that induce an abortion mailed to their home after participating in a telehealth appointment — without the need to see a physician to pick up the medication in person.

Here’s what you need to know about abortion pills and how the Supreme Court’s decision could affect access to them.

What is a medication abortion?

A medication abortion is a safe and effective way to terminate a pregnancy with the use of two drugs — called mifepristone and misoprostol — when taken up to 10 weeks after becoming pregnant, according to the Food and Drug Administration.

Before the FDA approved the abortion-inducing drug combination in 2000, which allowed people to have an abortion in their home, the only option for Americans to terminate a pregnancy was through a clinical procedure.

Medication abortions have since become the most common method for terminating pregnancies, according to the Guttmacher Institute, an abortion rights research organization.

How can people obtain abortion pills?

Though the drugs have been on the market for 22 years, they have long been difficult to obtain because of how the FDA has regulated them.

Until recently, abortion pills could only be given to patients in person by a specially certified provider. That made them more difficult to obtain than, say, contraceptives, which can be picked up in a pharmacy.

After temporarily suspending the in-person requirement during the COVID-19 pandemic — allowing people to get pills via telemedicine and mail delivery — the FDA indicated that it would make the change permanent in December of last year.

So, can anyone receive abortion pills by mail, without seeing a provider in-person?

No. Despite the FDA’s ruling, access to the medication still depends on which state you live in.

Julia Kaye, an attorney with the Reproductive Freedom Project at the American Civil Liberties Union, said that while the FDA’s recent decision is a “huge step forward,” individual states can still restrict how people get the pills.

According to the Guttmacher Institute, 19 states have already banned the use of telemedicine to prescribe abortion pills. Arizona, Arkansas, and Texas prohibit providers from mailing abortion pills to patients.

(Advocacy groups like Aid Access and Plan C offer information on how people can order the pills online, though the FDA warns against buying the pills from uncertified providers over the Internet.)

Does the Supreme Court’s decision affect access to abortion pills?

It could. Kaye said abortion bans would include both procedures and medication abortions. More states could also make abortion pills difficult to obtain by prohibiting physicians from prescribing the drugs via telemedicine (some states already do).

As of February, the Guttmacher Institute found that 16 states have introduced legislature to ban or restrict medication abortions. There’s a bill in Massachusetts state legislature that would prohibit the mailing of abortion pills and the use of telehealth to prescribe them.

Could telehealth and mail delivery still increase access to abortion pills?

Rachel Rebouché, the interim dean of the Temple University School of Law, said telehealth services and the ability to get abortion pills delivered by mail could help people who live in states where abortions are at risk of being banned.

In those states, people would need to travel to an abortion-friendly state to legally undergo any type of abortion, whether via a procedure or medication. Traveling still presents barriers, especially for low-income and marginalized groups, but the new way of obtaining abortion pills could be a game-changer, she said.

Traveling to a mobile health clinic, where someone could participate in a telehealth appointment, might be easier (and quicker) than traveling to a brick-and-mortar clinic for a procedure. And pills, unlike procedures, are portable, so they could be delivered to people in a state where abortions are legal.

“You could have someone pick it up for you,” Rebouché said. “I think that makes it harder to police.”

Of course, a slightly easier way to circumvent the system is no panacea.

“Many of those patients forced to travel are still seriously delayed because of the cost and burden,” Kaye said. “We will need to use every creative strategy to expand access.”