Melissa Harris-Perry: We're looking at how some of the policy choices of 2021 will shape this new year and beyond. Potentially among the most impactful policy choices is last month's decision by the FDA to allow individuals to receive abortion medication by mail rather than requiring the pills to be received in person from a specialized provider. Studies indicate the medication that induces abortion is highly effective and safe for terminating pregnancy within the first 10 weeks and the FDA first approved the medication more than 20 years ago.

The agency also imposed a REMS that's Risk Evaluation and Mitigation Strategy which made accessing the pills more difficult than in many other countries. That began to change during the COVID-19 pandemic when the FDA allowed mail-order distribution, a change that is now permanent. It's a big deal given that CDC research indicates nearly half of all abortions before 10 weeks are conducted with this medication. Mary Ziegler is a professor of law at Florida State University and the author of several books about abortion including Abortion and the Law in America, Roe v. Wade to the Present. Professor Ziegler, thanks for being here.

Mary Ziegler: Thanks for having me.

Melissa Harris-Perry: Can you give me a sense of how the FDA reached this decision to make the distribution change permanent?

Mary Ziegler: The FDA was facing this decision on data that have existed for some time that medication abortion is safe and that in fact there's no real medical benefit from an in-person dispensation requirement. This requirement as you mentioned has been around for a while but without a lot of evidentiary foundation to support it. I think that telehealth abortion experiences in other countries combined with data gathered during the pandemic only reinforce that conclusion.

Melissa Harris-Perry: Despite this ruling by the FDA, there are many states that ban the practice of receiving abortion medication via mail. I'm wondering are these abortion-specific bands or are they really about all mail-order prescriptions?

Mary Ziegler: No, these are abortion-specific bands, these are on states that have taken the position that medication abortion is unsafe for people who can get pregnant but also that abortion medication is different because it produces abortion that these states think is wrong.

Melissa Harris-Perry: Let me dig in on that for a second. When I hear you say that they've decided that this particular medication is unsafe, it is one thing to have a state policy position around abortion. It's another thing to presumably have a medical opinion which actually goes against the medical science.

Mary Ziegler: This is nothing new in the abortion debate states have taken the position that just as they view legacy media as unreliable, they view leading scientific organizations as unreliable too and is putting their support for abortion rights ahead of the facts. Even though there's scientific evidence for the safety of these drugs, states say that they don't trust that evidence.

Melissa Harris-Perry: This is a real basic question how much do these medications cost and is it prohibitive?

Mary Ziegler: It can be depending on resources. The price range varies dramatically from about 40 to several hundred dollars and it varies a great deal by state. Obviously, for some patients, we're talking about people who may not have reliable access to internet, much less access to several hundred dollars. It depends a lot on who you are, where you are, and how many resources you have.

Melissa Harris-Perry: When we say self-managed abortions, how is that legally defined?

Mary Ziegler: Self-managed abortion in many instances, there's no official federal legal definition. When we're talking about self-managed abortions we're talking about people largely doing this at home. There are telehealth abortions which may be somewhat considered self-managed but usually self-managed abortions are being done by someone without medical intervention or supervision. Telehealth abortions are a little different because while they're being done at home by the patient, there is a doctor monitoring much as would be the case with any other telehealth procedure.

Melissa Harris-Perry: I'm interested in what all of this might mean. On the one hand, you have this FDA ruling. It looks like we're going to have greater accessing. As we were researching on this looking at how the percentages have increased over the past 20 years so that many more of these early-week abortions are happening using this self-managed medication rather than surgically. Yet right now the Supreme Court is considering these cases, particularly the Mississippi case that is undoubtedly going to have far-reaching implications for surgical abortions.

I'm wondering will that case and its decision affect access to medical abortions?

Mary Ziegler: It will, states are going to try to ban all abortions surgical as well as medical. As a starting point, we think that's going to be somewhere in the ballpark of 20 to 25 states that number will almost certainly go up. I think you're right though to think that it will be harder for states to shut down medication abortion both legally and practically. While there will be effects, we would expect them to be less pronounced.

Melissa Harris-Perry: I'm thinking here about the Texas law which for its enforcement requires not the state but ordinary folks to tell on their fellow citizens basically. I guess I'm wondering if I'm getting a medication in the mail, how do that I'm getting it, or even what it's for?

Mary Ziegler: There definitely would be enforcement issues. I think it would probably have to be if someone's going to be reporting on you, it would probably have to be somebody who knows you, where you confided in somebody that that's what you're doing. These kinds of bands would probably encourage people I think unfortunately not to tell one another what they're doing and also not to seek out medical care if they have complications. Which is not out of the question with self-managed abortion because abortion medications can cause heavy bleeding.

Nothing that's usually that dangerous but there are occasionally complications. I think people's awareness that they could be in trouble if they're using these medications or if they're helping others use these medications, may lead people to silences that could be damaging at times.

Melissa Harris-Perry: I'm wondering about age restrictions as well when we're talking about mail orders. I'm remembering now a decade ago when under the Obama administration, the Department of Health and Human Services made a decision not to allow Plan B which is a different kind of medication. Not to allow Plan B to be sold over the counter. The discourse was about young people capable of pregnancy. I'm wondering with the self-managed abortions with the capacity for mail order, whether or not there is that same moral panic or reasonable medical concern about young people accessing it?

Mary Ziegler: I think there is but I think we're at a different point in the debate and so far as red states believe the Supreme Court is going to let them do whatever they want. To some degree, they care about young people accessing these medications but in large part, they care about banning the medications entirely. I don't want to characterize concern about young people and Plan B as a red herring but it's more the tip of the iceberg when it comes to concerns in these states about these medications.

You're much more likely to see states trying to ban the drugs outright and then try to shut down end arounds. Like people going out of state to get the medications, people prescribing the medications from out of state, and so on rather than focusing on one subset of folks who might want to use these drugs.

Melissa Harris-Perry: Mary Ziegler is Professor of Law at Florida State University, an author of Abortion and the Law in America, Roe v. Wade to the Present. Professor Ziegler, not only thank you for being here but I know that you're not feeling well and had to talk to us through a bit of a head cold so we really appreciate the time.

Mary Ziegler: Oh, thanks for having me.

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