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Julie Amaon wanted to make the process as easy as possible.

Her organization — Just the Pill — began facilitating abortions by mail in October. After they scheduled a call with a doctor, patients in Minnesota would typically receive their pill in the mail within a few days. Amaon, a family medicine doctor and medical director for Just the Pill, always followed up with a care package: Oreos, sanitary pads and a bag of peach mango herbal tea.

The entire operation screeched to a halt Tuesday night, when the Supreme Court lifted a national injunction that allowed women to access the abortion pill remotely during the coronavirus pandemic. Since July, patients had been able to request an abortion pill without ever setting foot in a clinic or a doctor’s office, an accommodation instituted to protect patients from the virus.

The 6-to-3 decision came as a surprise to some, said Julia Kaye, a lawyer for the American Civil Liberties Union and the lead counsel in the case. The court delayed making a decision on the case in the fall. The justices would reevaluate later on, they said, depending on coronavirus numbers. Tuesday’s decision came amid the worst coronavirus spike yet.

When the injunction was issued over the summer, abortion by mail was a relatively new concept in the United States. Previously, patients across the country were required to meet with a doctor in person before receiving their pill. Once that requirement was lifted, an abortion became far easier to access, especially for women who live in rural areas in antiabortion states, hours away from the nearest clinic. Abortion advocates worry that this Supreme Court ruling — the first since Justice Amy Coney Barrett was confirmed — could be a sign of things to come.

“It sends a chilling signal about the future of the right to abortion,” Kaye said.

Abortion pills require an in-person visit for good reason, said Catherine Glenn Foster, the president of Americans United For Life. Without a doctor present to administer the pill, she said, the patient runs a higher risk of serious health complications and is more likely to misuse the medication. (Statistically, serious health complications from the abortion pill are rare.)

“We are fooling ourselves if we refuse to recognize the dangers posed by abandoning women to suffer through the physical and psychological impact of chemical abortion without medical supervision or support,” Foster wrote in an email.

There is no medical reason that the abortion pill has to be distributed in person, Amaon said. The requirement, she said, often cuts women off from abortion. In Minnesota, the abortion clinics are clustered in cities on the eastern side of the state. Women in rural areas often have to stay overnight in a city, Amaon said, frequently driving three or four hours one way.

Amaon has focused on the communities of color clustered around the meatpacking plants in the southwestern corner of the state, she said. Many struggle to get time off work, she said. It has become even more difficult during the coronavirus pandemic, when families are often cut off from child care.

When a patient has to make a long trip and visit a medical facility in person, they substantially increase their risk of coronavirus exposure, Kaye said. Women of color are particularly affected: 53 percent of abortion patients are Black or Latina, groups that have been dying of covid-19 at a much higher rate.

“The Supreme Court told people of color that unnecessary risk of exposure to a virus that is disproportionately killing our communities is a fair price to pay for access to abortion,” Monica Simpson, the executive director of the reproductive justice nonprofit Sister Song, said in a statement.

The Supreme Court ruling is also a blow to doctors and nurses who are struggling to meet patient demand.

Appointments for medication abortions take an hour and a half, said Christina Theriault, a nurse practitioner at the Maine Family Planning clinics in Fort Kent and Presque Isle, rural towns in northern Maine. During the pandemic, only one patient is allowed in the clinic at a time, and the facility must be thoroughly cleaned between appointments. If Theriault can administer the abortion pill on the phone, she said, her schedule opens up. As the only medical provider at either clinic, she can see more patients — and she can see them sooner.

The Supreme Court ruling “feels like just another obstacle,” she said.

The abortion-by-mail process is more discreet, Theriault said. The pills arrive in an unmarked manila envelope.

Especially in conservative areas like northern Maine, women fear they will be discovered if they park outside of Maine Family Planning. “I think it gives patients more of a sense of control,” she said.

Ruling along ideological lines, the Supreme Court seems to have made a decision that was “never about the facts,” Kaye said. If they are willing to put women at risk during the pandemic, she said, she worries what other abortion rulings they may have in store.

There are 15 abortion-related cases either pending at the Supreme Court or “one step away,” Kaye said. With Roe v. Wade “hanging on by a thread,” she said, it is essential that President-elect Joe Biden makes abortion access a priority.

He could reinstate abortion by mail on “day one,” Kaye said.

Amaon had to call three patients on Wednesday, letting them know they could no longer access remote abortion care.

She’s not sure what they plan to do now.

Editor’s note: This piece contains an updated quote from Julia Kaye, the ACLU lawyer.

A previous version of this story stated that Minnesota law requires patients to meet with a doctor 24 hours in advance of their abortion. Patients are able to do these appointments over the phone. We regret the error.

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