Mr. Postman, look and see. Is there a tablet in your bag for me? - (3/23/2021)

By Dr. Ron Gasbarro 

Henry was waiting for the pharmacist to fill his prescriptions when he said, "Say, doc, where are you on the Supreme Court's ruling involving mail-order abortion pills?" "Oh no, you don't," thought the pharmacist. Like politics and religion, abortion should not be discussed with those who may oppose your views. Such a discussion has ruined many Thanksgiving dinners, several family vacations, and a few marriages of which the pharmacist knows.  

Henry was referring to July 2020, when the US Supreme Court suspended a rule that required patients to go to a clinic to pick up mifepristone, the first pill in a two-step process for a medical abortion. This suspension was due to the COVID-19 pandemic that kept people isolated inside their homes. However, on January 12, 2021, in its first abortion-related ruling with conservative Justice Amy Coney Barrett on the bench, the Court upheld the Trump administration's request to reinstate the in-person mandate.  

This ruling sparked an atmosphere of disagreement among the nine Supreme Court justices that is more politically motivated than respectful of patients who want a safe, private, and legal end to their pregnancy. Justice Sonia Sotomayor wrote in her dissent that of the 20,000 FDA-approved drugs, mifepristone is the only drug the FDA requires to be picked up in person.  

The American Civil Liberties Union (ACLU) has gotten involved saying that the ruling would essentially harm women of color and those of low-income "who make up the majority of impacted patients and who are suffering severe complications and dying from COVID-19 at disproportionally high rates." Without the mail-order opportunity, women are jeopardizing their health by taking matters into their own hands. Case in point: in Texas, which has some of the most draconian abortion laws in the country, women attempt to self-administer abortions more than three times the national average, new peer-reviewed research shows. A recent study from the Texas Policy Evaluation Project revealed that 7% of patients seeking abortions at Texas clinics had tried to terminate their pregnancies before asking for the safer procedure. Compare this to the national average of roughly 2%.  

"Lifting the restrictions on medication abortion can dramatically expand access," said Sung Yeon Choimorrow, executive director of the National Asian Pacific Women's Forum. "People should be able to get the care and information they need to have an abortion on their own terms, whether that is at a clinic or in their home, and without fear of punishment." By using the mail-order approach, patients can receive both drugs, a home pregnancy test, and pain medications without fear of catching the virus. They can complete their procedure without entering a high-risk environment such as a clinic.  

The pharmacist has long believed that women have the right to choose what they want to do with their bodies – the same way men do. Women have fought long and hard – and are still fighting – for their right to practice birth control and to have a legal abortion if they choose – 48 years after Roe v. Wade made abortion an American right, supported by the US Constitution. The pharmacist knew that Henry was not open-minded about this topic, hence the pharmacist's reluctance to discuss it with him. "Ask me which cough drops are on sale instead," he said jokingly to Henry.  

Ron Gasbarro, PharmD, is a recovering pharmacist and writer-in-residence at Rx-Press. 

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