On Tuesday, South Dakota Gov. Kristi Noem signed an executive order restricting medication abortion—increasingly the safest and most common choice for women who can’t access the in-clinic procedure—across the state.
According to the Argus Leader, Noem’s mandate bans out-of-state physicians from prescribing South Dakota patients abortion pills; it also prohibits anyone else from providing residents with the medication, such as those who would deliver the pills in the mail or via telemedicine or courier. This blocks more than a third of first-trimester abortions and specifically targets those who have the least access to the procedure: low-income women, women in rural areas, and women of color.
Though the executive order bears little resemblance to Texas’s six-week abortion ban, it was clearly somewhat inspired by it. After seeing Texas lawmakers’ success at avoiding court injunctions with S.B. 8, Noem said that she directed the anti-abortion advocates in her office to review the legislation and make sure South Dakota has “the strongest pro-life laws on the books.”
As a result, Noem has banned one of the safest, easiest forms of abortion. Medication abortion is a method that involves mifepristone and misoprostol, two medications that come in pill form. As of 2017, some 40 percent of all abortions in the United States were performed using pills—and that’s not accounting for the tens of thousands people who have ordered the pills online through services like Aid Access and used them to give themselves abortions at home. Researchers and medical experts widely agree that there is not a significant difference between obtaining the pills in the mail versus at a clinic or hospital: Studies have shown that mifepristone and misoprostol are overwhelmingly safe and effective, even when administered outside of a traditional clinic setting.
It’s obvious that abortion opponents aren’t particularly concerned with what is “safe and effective,” though they may claim that their restrictions are for women’s safety. It’s also clear that conservative lawmakers and politicians are also beginning to consider how their fight against abortion may change after they’ve effectively shuttered every clinic in their states—as many are hoping to do by deploying the same legal mechanism as S.B. 8.
If a patient can use pills to end an abortion—particularly if they buy them on the internet—they can largely avoid abortion clinics, which have served as the primary sites of anti-abortion activists’ restrictions, harassment and daily protests. This prospect is infuriating to abortion opponents because it is something they can’t control.
Even with the FDA’s longtime restrictions on mifepristone—which required the drug to be dispensed in person until Trump and Biden both suspended the requirement during covid—people have managed to get the pills in the mail and give themselves affordable abortions in the privacy of their homes. This practice will continue, even if Noem’s executive order stands: Telemedicine abortion is of course banned in Texas too, but hundreds of people requested (and likely received) pills in the mail when Governor Greg Abbott banned abortion for a month in 2020. And hundreds of more will do the same as long as S.B. 8 stays in effect. Noem’s mandate may scare and intimidate people considering giving themselves abortions with pills—but it can’t stop them.