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Survey finds widespread confusion around medication abortion in post-Roe US

By Deidre McPhillips, CNN

Nearly half of adults in the United States — including 2 out of 5 women of childbearing age — are unsure whether medication abortion is legal in their state, according to a survey released Wednesday by the Kaiser Family Foundation.

The survey was conducted in mid-January, more than six months after the US Supreme Court issued the Dobbs decision that overturned Roe v. Wade and revoked the federal right to abortion.

Several states had “trigger bans” that took effect in the weeks after the high court’s judgment, with laws that ban or severely restrict abortion. But some of those laws are in limbo as they face challenges in courts.

The legal landscape around abortion was rapidly even before Dobbs, experts say. New telehealth rules put in place during the Covid-19 pandemic offered additional pathways to access medication abortion. State legislatures are now in session for the first time since that decision, which is sure to bring more change.

“It’s fair to be confused about all of the different ways in which somebody can get access to medication abortion and wonder which ways are legal and which ways are a little bit more outside of the legal framework,” said Asha Hassan, a researcher with the University of Minnesota’s Center for Antiracism Research for Health Equity who focuses on reproductive health.

“We’re in a learning curve right now. But then, the education has to change because it is constantly a shifting climate.”

Both in states where abortion is banned and in those where it is legal, about half of adults are not sure about the legal status of medication abortion in their state, according to the KFF survey. And some are getting it wrong.

In states where abortion is banned, about 13% of adults incorrectly think that medication abortion is legal. And in states where abortion is legal, about 10% think that medication is banned.

This confusion can be a barrier on its own, said Kirsten Moore, director of the Expanding Medication Abortion Access Project. Spreading awareness and battling misinformation is a key priority for the White House and other advocates.

For politicians and others who are anti-abortion, “it’s not just about actually passing laws that make it illegal. It’s about creating a perception of danger of risk,” she said. “Even if active steps are not taken, the perception of legal risk can deter people.”

President Biden has called for action to specifically protect access to mifepristone, a drug used in medication abortion that is approved by the US Food and Drug Administration. In early January, the FDA approved a measure that would allow certain pharmacies to supply the drug directly to patients with a prescription. That expands access, as medication abortion was previously available only through certain health care providers. But it has never been available over-the-counter.

Most abortions in the US are medication abortions — as opposed to the medical procedure — according to the Guttmacher Institute, a research and policy organization focused on sexual and reproductive health that supports abortion rights.

But there is still some confusion around how to access a medication abortion. About half of adults are not sure whether medication abortion requires a prescription, according to the KFF survey. About 1 in 10 adults incorrectly believe that it does not require a prescription — including nearly as many women.

Most adults (62%) know that emergency contraceptive pills, known as the morning after pill or Plan B, are not the same as the abortion pill. And most adults know that contraceptive pills are available in their state, as they are in all 50 states. But nearly three-quarters think emergency contraceptive pills can end a pregnancy in its early stages.

“There’s a lot of growth and work that we can do within the health care industry and environment to make sure that people know that [medication abortion] is safe, and something that is extremely accessible compared to surgical abortion right now,” Hassan said.

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