On March 11th, the Carolina Journal published the following op-ed by Ashley Vaughan, NC Values Press Director, and Mary Summa, NC Values General Counsel, entitled “NC Law Being Circumvented with Risky Abortion-Pill Scheme”:

Texas attorney Mason Herring told his pregnant wife, Catherine, that she really needed to focus on her hydration. When he brought her a glass of water, she noticed it looked cloudy, but she drank it anyways. Soon, Catherine was in excruciating pain and began bleeding. She delivered their baby girl 10 weeks early. It was later discovered that Herring spiked his wife’s water with misoprostol — a pill that induces abortion.

Since the Supreme Court overturned Roe v. Wade in the summer of 2022, there has been an explosion of abortion drugs being sent to women through the mail and, with that, an explosion of new problems. Right now, any North Carolinian can go online and have the two-drug regimen of mifepristone and misoprostol sent directly to their mailbox — despite the fact that mailing abortion pills is illegal in our state.

Out of state providers are breaking our laws by providing telehealth abortions; rogue websites are sending unapproved abortion pills from India; and, as with the case of Mr. Herring, there is no way to know if mail-order abortion medications are administered without violating informed consent. All of this puts North Carolina women at risk.

Despite what Planned Parenthood says, abortion drugs are not as safe as Tylenol. Research shows us that mifepristone and misoprostol are associated with significant morbidity and mortality — and the current FDA AER underestimates the adverse events from mifepristone. One in 5 women will experience a complication, including hemorrhage, infection, incomplete abortion, and death. Approximately one in 25 women who undergo medical abortion will need to seek care in emergency departments according to the FDA label. Approximately the same number require surgical completion of the abortion.

But despite these risks, on Dec. 16, 2021, using COVID as an excuse, the FDA relaxed the in-person appointment requirement, allowing telehealth abortions and allowing the pills to be mailed. In-person care is critically important for reducing risks associated with these medications.

An ultrasound is needed to determine the gestational age of the baby prior to medical abortion because the risk of complications increases as the pregnancy advances. For this reason, abortion pills are only FDA approved up to 10 weeks. An ultrasound is also needed to rule out ectopic pregnancy because ectopic pregnancy that is left untreated after a woman takes the abortion pill can cause infertility and even death.

And the emergency care system is not equipped to provide the personalized attention and continuous care that women undergoing a health event of this serious nature need — they need to be under the supervision of a doctor who knows them and is following their case. Emergency rooms are frequently used to treat abortion pill complications, without the treating physician even knowing that the underlying cause is the abortion pills.

Furthermore, mail-order abortion pills jeopardize the entire enterprise of informed consent, which is meant to ensure that women properly understand the risks and complications of abortion drugs. And there is no way to confirm that the person who ordered the pills is the same person who will end up taking them.

For the safety of North Carolina women, our state laws specifically ban direct-mail of abortion drugs (NC General Statute 14-44.1) and the use of telehealth for drug-induced abortion (NCGS 90-21.83A). Telehealth abortions were first prohibited in North Carolina in 2013 and were kept in the law with the passage of SB20 in 2023. Although challenged by Planned Parenthood (Planned Parenthood South Atlantic v. Stein, 1:23-CV-480), the court allowed the provision to remain in effect.

The laws, NCGS 90-21.82 (for surgical abortions) and NCGS 90-21.83A (for chemical abortions) require in-person counseling 72 hours before an abortion. The laws also require determination of the probable gestational age of the baby, a display of a real-time view of the baby, and heart-tone monitoring. They require that the woman initial an informed-consent document that she has been informed, among other things, about the risks and possible complications from the abortion, that the abortion is voluntary, and that she has been provided the name and contact information of a physician who can provide care in case there is a complication.

All of these laws are being ignored by bad actors who are mailing thousands of abortion pills to North Carolina women every month.

Unaccountable out-of-state doctors and unapproved websites have seized on mail-order abortion as a way to make a profit off of vulnerable women. Abortion kits cost approximately $5 to produce, yet these vendors charge between $30 and $500 per kit. According to a May 14, 2024, article in The Guardian, between January and May 2024, medical providers shipped abortion pills to over 40,000 people living in states that prohibit abortion.

The Guardian claims that 2,000 abortion kits are being shipped into North Carolina each month. To ensure legal protection, most of these doctors reside in states that have enacted “abortion shield laws,” which prohibit any government cooperation if the doctor is criminally charged or sued for violating the laws of states like North Carolina which have strong protections in place against abortion drugs.

Even more concerning — rogue websites are shipping these drugs into the country from overseas, making it impossible to trace their origin or content. The websites mail abortion drugs directly to women without a medical consult, without a prescription, without requiring the women to upload identification, and without any kind of follow-up support. These pills are not FDA approved or monitored by the US government. To date, no one, including the FDA, has attempted to stop their shipment, despite federal laws that make shipments of unapproved pills illegal.

States are beginning to take matters into their own hands. In Louisiana, where abortion pill shipments are illegal, on Jan. 31, 2025, a grand jury indicted a New York doctor, Dr. Margaret Carpenter, who shipped abortion pills to the mother of a pregnant teenage girl. The mother forced her daughter to take the pills. The mother was also indicted. Action was also taken against Carpenter in another case, with Texas Attorney General Paxton suing her for shipping the drugs to a 20-year-old. Both the Louisiana girl and the Texas girl suffered complications and ended up in the emergency room.

North Carolina law, thanks to SB20, specifically makes it a crime to ship abortion drugs if the shipments are in violation of North Carolina abortion restrictions. The penalty for a violation, however, is simply a fine, and the law provides no civil remedy for a woman harmed by these pills.

Weak penalties have not deterred bad actors from endangering North Carolina women. More needs to be done to protect women. The penalty should be increased to a felony, and we need to create a civil cause of action for women injured if the provider bypasses the state requirements for in-person counseling, informed consent, shipping the pills in the mail, and the 72-hour waiting period. We also need to change state law to prohibit the shipment within or into North Carolina of abortion pills not approved by the FDA, since the Federal government is not enforcing that law.

State legislators should protect North Carolina women from the harm that is being done by mail-order abortion drugs.

Ashley Vaughan is the press and political director for NC Values.

Mary Summa is the general counsel for NC Values.