When we usually think of abortion clinics, we think of Planned Parenthood centers or abortionists’ operations, which usually center in poor and minority neighborhoods. But now, thanks to the Food and Drug Administration, there could be an abortion clinic wherever there’s a drug store.

How is this possible?

Abortion Drugs

Over half of abortions in the United States are now done by prescription drugs. There is a two-drug regimen. The first drug is mifepristone and the second is misoprostol. The two pills work in tandem to kill an unborn child and to expel her remains. The macabre idea is for women to have a do-it-yourself abortion at home. Basically, a return to the back alley.

The abortion industry – which includes the pharmaceutical companies that make these drugs – has long claimed that this is a safe alternative to surgical abortions early in pregnancy. They’re lying.

Obviously these drugs are always deadly to the unborn child. But they’re dangerous to the mother too. According to the Charlotte Lozier Institute, a leading pro-life research group, there are many grave dangers to women’s health, particularly since they are taken without direct medical supervision. These risks include:

• Four times the complication rate compared to surgical abortion.
• Up to one out of five women will suffer a complication, with the risk increasing with gestational age.
• 3 to 7% of women will need follow-up care to finish the abortion.
• 7 to 10% need follow-up care for chemical abortions after 9 weeks of pregnancy.
• Up to 39% need surgery if the pills are taken in second trimester.
• As much as 15% of women will experience hemorrhage, and 2% will have an infection.
• The rate of chemical abortion-related emergency room visits increased over 500% between 2002-2015.

For those who are never satisfied with enough abortions, these risks to women are mere collateral damage. Their main goal is to kill the baby, and for that purpose the drugs are exceptionally effective.

What did the FDA do?

For years, the FDA only allowed doctors, clinics, and some mail-order pharmacies to dispense mifepristone (because misoprostol can be used for legitimate purposes, it is already available at pharmacies by prescription). That approval, which was first given in 2000, was based on junk science. To get around legal requirements, the FDA falsely redefined pregnancy an “illness” and absurdly claimed that the abortion drugs provide a “meaningful therapeutic benefit” over existing treatments.

Even worse, the FDA never studied the safety of the drugs when they are used for abortions, despite being required to do so by federal law. They consistently ignored the risks that emerged once the drugs were being used. And they even courted further risk by extending the approved time for taking them from 7 to 10 weeks of pregnancy.

In 2021, the FDA again expanded access to these dangerous drugs. They decreed that it would no longer be necessary for a woman to see a doctor in person to get the drugs, but instead they could be sent to her by mail. This was in defiance of a specific federal statute that banned the mailing of abortion articles.

And now the FDA has gone even further. On January 3, 2023, the FDA announced a new policy that permits any patient to obtain mifepristone from a local pharmacy. A pharmacy itself can qualify to dispense the pill merely by filling out a form with the FDA.

CVS and Walgreens, the dominant pharmacy chains, have already announced that they will begin to dispense abortions in some of their stores. So soon, there may be a de facto abortion clinic in your neighborhood.

What Can be Done?

There has already been an outcry from pro-life groups. The US Bishops issued a strong statement condemning this move. More groups and prominent individuals should certainly follow suit.

This new policy conflicts with various state laws. Two states ban the pills after a certain point of pregnancy (seven weeks in Texas and 10 weeks in Indiana). Twenty-nine states require abortion pills to be administered by physicians and eighteen more require the doctor to be physically present when the pills are taken.

Since the regulation of medical practice is generally within the power of states, rather than the federal government, these laws should withstand challenges. But state legislators and regulators could always change them to conform to the new FDA policy, and many of these laws are being challenged under state constitutions. Plus, with the approval for mail-order drugs, the laws will be easily evaded.

As for a challenge to the FDA policy itself, it’s hard to be optimistic. Thanks to the rise of the Administrative State, it is extremely difficult to challenge agency decisions by litigation. Courts give great deference to decisions by executive agencies under the theory that experts know best, and judges shouldn’t second-guess them.

That may presage the fate of a lawsuit against the FDA by pro-life doctors, filed last November by Alliance Defending Freedom. They are asking the court to vacate the FDA’s approval of the drugs as an abuse of authority, on the grounds that the FDA failed to evaluate the safety risks.

The new policy also directly threatens the conscience rights of pharmacists who do not want to cooperate in abortions. This will require close attention to federal, state, and local human rights laws. There are many protections against adverse employment action based on a person’s religion. But applying those laws can be very technical and difficult. Religious liberty groups like Becket and ADF, and pro-life employment lawyers, will likely be busy with cases.

Religious employers are also going to have to pay close attention to the coverage offered under their prescription plans. Self-funded plans may be able to resist, but commercial plans are likely to cover the abortion drugs. Employees who contribute to those plans may have no other options.

There have been calls for consumer protests and boycotts of the major pharmacy chains based on their decision to provide the abortion drugs. I am generally skeptical of the success of these kinds of campaigns, especially when they target gigantic conglomerates. But there have been successes by pro-lifers and other interest groups in convincing companies to change their policies. Small independent pharmacies that are embedded in our communities may be more amenable to refusing to dispense the drugs. It is certainly worth trying, at least to protect one’s own conscience.

Resisting Collaboration

One of the typical tactics of totalitarian regimes is to induce everyone to cooperate or acquiesce. That way, everyone is a collaborator and everyone is morally compromised.

The idea that abortion and these lethal drugs are “health care” is a lie. The most important tactic is our willingness to testify to the truth by our words and our actions, and our refusal to cooperate with injustice and lies.

We need to listen to the great dissident, Alexander Solzhenitsyn: “You can resolve to live your life with integrity. Let your credo be this: Let the lie come into the world, let it even triumph. But not through me.”