Nearly one quarter of women in the U.S. will have an abortion by the age of 45. Many of these abortions will be performed using medication. And in an era of telemedicine, experts say it has never been easier to access abortion at home — with or without the support of a medical professional.
But new bills in the Missouri statehouse are taking aim at those who help pregnant people self-administer a medication abortion by providing pills, prescriptions and even information about the procedure.
We consulted experts on abortion law and care access in Missouri and Kansas to bring you this no-nonsense guide to so-called "abortion by mail."
How does a medication abortion work?
Most medication abortions involve two medications, called mifepristone and misoprostol. Mifepristone stops a pregnancy from progressing, and misoprostol is taken a day or two later to empty the uterus. This procedure generally takes place during the first 10 weeks of pregnancy.
Even if you visit a clinic in person to obtain these medications, a provider may still instruct you to take them at home. That's part of why many pregnant people in the U.S. now opt for telemedicine abortions, in which care is available virtually and the entire process can take place in the comfort of your own home. COVID-19 has only contributed to the demand for this type of care.
Is telemedicine abortion legal in Missouri or Kansas?
Both Kansas and Missouri prohibit healthcare providers from providing telemedicine abortion care, but current laws do not prohibit pregnant individuals from seeking or receiving telemedicine abortion care.
"Kansas and Missouri [law] doesn't make it a crime to access that care yourself," said Sara Ainsworth, Senior Director of Legal & Policy for If/When/How, a legal aid organization focused on abortion law. "It doesn't criminalize the person who has an abortion."
Telemedicine abortion is legal in 31 states, restricted in 14 states including Missouri and Kansas, and completely banned in five states.
A recent bill sponsored by Branson, Missouri, Republican State Rep. Brian Seitz would further punish out-of-state pharmacists for helping Missouri residents have a medication abortion. It would also make "trafficking abortion inducing devices or drugs" a felony, although the bill specifies that doing so would be illegal "for the purpose of performing or inducing an abortion on another person," not on yourself. The bill is not expected to pass.
Can Missouri or Kansas residents get abortion care from a provider in another state?
Legally, yes. The problem many pregnant people run into is that providers are only licensed to prescribe medication in one particular state. A doctor in Massachusetts, for example, can't prescribe abortion pills to someone in Missouri. The closest state to Missouri that mails abortion medication within its own borders is Illinois.
Another bill currently being considered in the Missouri House would make it illegal for anyone to help a pregnant person self-manage an abortion or to possess or transport abortion medication, including through the mail. However, the bill makes an exception for "conduct taken by a pregnant woman who aborts or seeks to abort her unborn child."
The Star will report more on these abortion-related bills as they progress.
How can I access medication abortion services in Missouri and Kansas?
One way is to visit an abortion clinic in person. Here's our overview of where and how to do that in the Kansas City area. However, this option is not viable for everyone. For those who prefer to self-manage an abortion at home or get a prescription and medical advice virtually, the nonprofit group Plan C offers examples of how pregnant people in every state can and do access this care.
"[In] states like Kansas and Missouri, politicians are legislating to create these barriers which are not medically justified," said Elisa Wells, co-director of Plan C. "We want people to have [this] information so that they can make their own decisions."
Plan C has tested and verified the claims of the abortion medication providers listed on its website. Wells told The Star that this process included checking these online pharmacies' shipping times and testing the medications they delivered in a lab to ensure they were legitimate. Her group functions as a resource guide and does not directly offer legal or medical advice.
Where can I go for legal or medical advice regarding a self-managed abortion?
If/When/How runs a free and confidential legal helpline for questions about reproductive healthcare. The helpline can offer advice about your specific situation in your state, including your options if you're under 18 years old. You can contact the helpline directly by calling 844-868-2812.
If you have questions for a doctor before, during or after an abortion, help is available. You can call or text the Miscarriage and Abortion Hotline at 833-246-2632, or connect with the Ally chatbot over WhatsApp at 833-221-2559.
Is abortion medication safe?
Experts say yes. Mifepristone has been approved by the FDA to safely end pregnancies for more than 20 years. The American College of Obstetricians and Gynecologists has also supported its use. Studies have shown that abortion medication is 99.6% effective at ending pregnancies, and that its risk of complications is extremely low.
For specific questions about the safety of abortion medication on your personal health, it's always best to consult a medical professional.
