Will Florida’s strict six-week ban be bypassed by abortion by mail?

Florida will this week begin enforcement of a six-week abortion ban, the state’s strictest limits on the procedure in more than 50 years. The law penalizes doctors who perform abortions with sanctions that could include revocation of their medical license.

The ban covers abortions through medication, but abortion-by-mail providers say they will continue sending pills to women in Florida — even those beyond six weeks pregnant.

Here are six key questions answered about medication abortions and how this evolving legal situation might play out.

What does the six-week ban mean for abortion pills?

Both surgical and medication abortions are banned after six weeks, a point at which many women don’t know they are pregnant.

There are exceptions for rape, incest and human trafficking through 15 weeks of pregnancy, as long as the mother provides proof such as a medical record or police report.

Doctors are also able to perform an abortion after six weeks if they determine a woman will die or suffer a serious health complication without the procedure, or if the fetus has a fatal abnormality and has not reached the third trimester, which Florida law defines as at 24 weeks of pregnancy.

How many medication abortions occur in Florida?

Roughly 60% of Florida abortions — more than 46,000 — were done through medication in 2021, according to data collected by the Centers for Disease Control and Prevention.

The drug mifepristone, which blocks a hormone that’s needed for a pregnancy to continue, is used with misoprostol, a stomach ulcer medicine, through 10 weeks of gestation.

Federal regulators have approved both a brand name version of mifepristone, Mifeprex, and generic pills. They say medication abortion is safe and effective.

Women take mifepristone to terminate the pregnancy, then up to two days later use misoprostol, which causes cramping and bleeding to expel it. Side effects may include nausea, weakness, fever, chills, vomiting and headache.

Women with a fetus developing outside of the uterus, those on blood thinners and individuals with an intrauterine device, or IUD, shouldn’t take mifepristone and misoprostol, according to the U.S. Food and Drug Administration. The full list can be found on the agency’s website.

What’s happening at the U.S. Supreme Court?

The nation’s highest court listened to oral arguments in March in a case brought against the Food and Drug Administration by a coalition of anti-abortion physicians and medical groups.

In addition to alleging that abortion medication is unsafe, the coalition asked the court to overrule the federal agency’s 2021 decision to allow prescribers to send pills by mail, waiving a previously required in-person visit. The court has yet to issue a ruling, but a majority of justices seemed skeptical of the coalition’s argument.

Can Florida women get abortion pills by mail?

The short answer: yes. That’s despite the six-week ban law including an explicit prohibition on doctors prescribing medication abortions through telehealth and sending pills in the mail, requiring that physicians dispense the drugs in person.

Several states, including California, Illinois and New York, have passed “shield laws” to protect telehealth providers from out-of-state civil and criminal investigations if they send abortion pills into states like Florida. How clashing abortion laws will play out is a “new frontier,” said Caroline Mala Corbin, a University of Miami School of Law professor.

Providers from other parts of the U.S. are shipping abortion medication into Florida every day, said Amy Weintraub, the reproductive rights program director at Progress Florida, a St. Petersburg nonprofit.

That includes groups like The Massachusetts Medication Abortion Access Project, part of a nonprofit that provides medication to pregnant women provided their last menstrual period began no more than 11 weeks earlier.

The service includes a review of medical history by clinicians and a follow-up online questionnaire. The normal charge is $250 but the group operates a pay-what-you can program. Medication typically ships in two to five days.

“Our aim is to have pills in people’s hands by 12 weeks,” said Angel Foster, president and co-founder.

Aid Access, a group based in Austria and the Netherlands, helps about 750 pregnant people in Florida each month get abortion pills from telehealth providers in shield law states, said Rebecca Gomperts, the organization’s founder and director. The drugs arrive within five days for those up to 13 weeks pregnant, she said.

Weintraub is worried that many Florida women do not know that medication abortion is still an option.

“It’s a normal service that is a part of every modern health care system world wide,” she said. “We’re trying hard to spread the word about how people can legally share information about acquiring and using pills by mail.”

What are the legal risks for patients?

Generally, laws don’t target women who undergo abortions — they instead create penalties for doctors who provide them, Corbin said.

But there’s a caveat in Florida, she said. According to the law, anyone who “willfully performs, or actively participates in,” an abortion that violates state restrictions commits a third-degree felony.

“The $10,000 question is who is covered by ‘actively participates in,’” Corbin said. “The language is ambiguous enough that an ambitious prosecutor might try (to) expand the reach of the law.”

But Corbin said she thinks it would be “politically dangerous” for the state to go after women who end their pregnancies. Majorities of both Democrats and Republicans in a national NPR/PBS NewsHour/Marist poll, conducted in March, said women shouldn’t face penalties like fines or jail time for getting an abortion.

A spokesperson for Gov. Ron DeSantis declined to comment. In an interview last year with CBS Evening News, DeSantis said the law targets abortion providers — not patients. He said he doesn’t support criminalizing women.

“That will not happen in Florida,” he said.

A legal case from Pinellas County suggests that women can’t be held criminally liable for abortions. In 1997, the state Supreme Court ruled that a teenager charged with murder and manslaughter for shooting herself in the stomach to terminate a pregnancy couldn’t be prosecuted for self-managing her abortion.

But the current court has shown a willingness to depart from precedent when it comes to abortion, Corbin said. That makes it less clear how the conservative-leaning justices would interpret the law.

What about medical risks?

The Food and Drug Administration doesn’t recommend that women buy abortion pills online unless it’s from a certified health care provider. Prescription drugs purchased from international sources are typically not approved for use in the U.S. Regulators can’t ensure they are safe and effective.