No, Abortion-By-Mail Is Not A Solution To Dwindling Access

In 2015, Polish women briefly dominated headlines in English-speaking media at a time when American media was navel-gazing at the Republican presidential primaries. The Abortion Drone took its first flight across the border from Germany to Poland, bringing abortion pills to a country where abortion care is both largely illegal and inaccessible.

In the years since, I’ve heard people casually bring up these drones (and the ships used for decades by Women on Waves to bring abortions to countries without abortion access) as a viable solution to the continuing erosion of abortion rights. These solutions are usually proposed by well-meaning people who have only recently realized abortion access is in legal trouble. It’s not fun to realize something you took for granted is being eliminated, and people want to help! That’s great.

Sadly, the lack abortion access in the United States can not be solved by drone or by ship or even just by mail, as The Atlantic argued earlier this week. Writer Olga Khazan attempted to persuade worried abortion-rights-favoring readers that the reason for all the anti-abortion madness is that pregnant people are simply uneducated, and that it’s the fault of activists, particularly in Texas, for not better publicizing abortion care by mail. This story is based around findings from one question poll by Leger/Atlantic, which asks: Have you heard of any of the following organizations—Abortion on Demand, Plan C, Aid Access and Carafem?

I reached out to Leger360 for access to the full poll on Wednesday, but they have yet to get back to me. (This organization hasn’t signed onto the American Association for Public Opinion Research’s Transparency Initiative.) So, all we have on which to evaluate Khazan’s analysis is the methodology listed in her piece: “The poll surveyed a representative sample of 1,001 adults across the country from September 24 to September 26.”

While polling this small can be used — with proper random sampling and weighting — to extrapolate to what all U.S. adults think, this particular question is flawed and designed to get a specific answer. Topic and issue polling should be curious and expansive to understand what a specific population believes or perceives about the world around them. Instead, the polling cited by The Atlantic has beget a story that focuses on a few of these listed organizations, saying that medication abortion by mail is an unknown quantity. This sentence, in particular, is troubling: “Its results mirror my experiences interviewing two dozen random young Texans recently.” Asking twenty-four people whether they’ve heard of a few specific organizations is not an adequate polling sample from which to reach broader conclusions about abortion knowledge and access.

Francine Coeytaux, co-founder of Plan C, a group mentioned in the poll, told Khazan that abortion clinics in Texas and abortion funds for Texans are not promoting abortion pills because it might undermine their own work. “The strategy of the lawyers and the providers and everybody who’s fighting for our rights … is ‘Oh my God, look what happened. In Texas, there are no options anymore,’” Coeytaux said. “If you come along and say, ‘Maybe your problems of access have just been solved, because you don’t have to travel, you don’t have to pay that much,’ that undermines the Oh my God, this is really terrible.”

In Texas (as Khazan notes), doctors can’t prescribe abortion pills by mail. And even if they were legally allowed to, this is a state that saw the closure of more than half of its then 42 abortion clinics after HB2, the law that filibustered by then state Sen. Wendy Davis in 2013. The reality in Texas is that the government has regularly chipped away at people’s constitutional rights, most recently enacting a law that narrowed the window for medication abortion from 10 to 7 weeks into pregnancy.

Since Khazan’s piece came out, which gave credence to anti-abortion group’s assertion that abortion is an unsafe (it’s not) and that the right to the procedure is unpopular (it’s popular), Coeytaux has walked back her words in two tweets late on Wednesday night.

It’s not that “people in large swaths of the country feel they have no options” but to continue a pregnancy, as Khazan writes; this is literally the case. Medication and procedural abortion are safe and effective, but it’s still difficult to obtain a medication abortion if your state outlaws it or requires a doctor to be present.

If your argument against the looming legal outcome of outlawing abortion is that not enough people have heard about this one weird trick, you’ve already conceded too much to the other side. Medication abortion is not a solution to a lack of legal protections for patients and workplace safety for providers. It’s not a solution to the fact that 38 states require licensed physicians (ruling out nurses, midwives) to perform the procedure, or the fact that 25 states have mandated waiting periods and 18 require counseling that usually contains medically inaccurate information.

Each year, more anti-abortion legal restrictions are put into place at the state level, while federal representatives cheer on the anti-abortion activists’ efforts or rely on silence to lean into their own cowardice. State governments have enacted 1,335 anti-abortion laws since 1973, when the Supreme Court agreed women were full citizens, according to the Guttmacher Institute. Forty-four percent of those anti-abortion laws were passed in the last 10 years. This year, state lawmakers reached a new high, with 106 restrictions passed (as of Guttmacher’s last counting in mid-September), and some state legislatures are still in session.

People in Texas, like people everywhere, deserve safe and legal abortion methods. Medication abortion is a good option for some patients, but it should not be used as a bargaining chip to call an abortion ban not that bad, when those bans often include the very method that’s supposed to give pregnant people an out. It’s silly to hold up clandestine care as the only kind worthwhile or worth fighting for.

The fight for abortion care will always include both — even if you’re not yet informed.