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If abortion medication is illegal, how can it be enforced? A physician weighs in

Woman taking medicine. Original public domain image from Wikimedia Commons

Woman taking medicine. Original public domain image from Wikimedia Commons

Like other historically conservative states, Indiana quickly banned abortion as soon as it could last year. But how will the state stop Hoosier women from giving themselves the most common type of abortion, by medication? WVPE’s Jeff Parrott has more.

Shortly after the Supreme Court last June struck down the 1973 Roe vs. Wade decision that had legalized abortion for nearly five decades, Indiana became the first state to enact an abortion ban. The Indiana General Assembly convened a special one-day session just to pass the ban into law.

The new Indiana law makes it a crime to provide an abortion except for certain exceptions. It prohibits abortions at any point during pregnancy except if the woman's life or health is seriously at risk. Abortion would be permitted before 22 weeks of pregnancy if a "lethal fetal anomaly" is detected, or until 12 weeks of pregnancy in cases of rape or incest.

But women in any state can easily buy abortion pills online, on websites like and So in a nation where most abortions are now done with a pill rather than in a clinic, things are anything but clear.

Joining me in an attempt to clarify things is Dr. Cynthia Heckman-Davis, a retired physician who remains board-certified in family medicine in the South Bend area. Hello Doctor.

Heckman-Davis: Hello Jeff.

Question: Now, you’ve never performed abortions but you’ve said you’ve had patients over the years who chose that option and were glad that they did.

There seems to be a lot of confusion right now about the legality of abortion in Indiana. In Indiana, can a pregnant woman who buys abortion pills online be charged criminally for giving the pills to herself without a doctor’s involvement? How would prosecutors know?

Answer: That’s an excellent question. The pregnant person is not specifically criminalized but it is illegal in Indiana to take medications to induce an abortion. So it is possible that a person could be charged for taking an abortion medication. It would be impossible for a doctor to know whether this complication, if there is one – there usually isn’t – is due to an abortion or a natural miscarriage. After all, a natural miscarriage involves the same bleeding, the same hormone levels, as early abortion and there’s no way really to distinguish between the two. A doctor would not be able to know so I don’t think a prosecutor would know unless the woman herself said, ‘Yes, I did this thing.’

Q: What is NOT illegal under the 2022 Indiana abortion law?

A: Crossing state lines is not illegal. Ordering by mail or possessing abortion medications is not illegal as long as the medications were legally prescribed, although taking them is illegal. Visiting a website such as carefm, plan C, Planned Parenthood or Whole Woman’s Health, is not illegal. Out-of-state physicians legally prescribing medications remains legal. Most of this is covered under the federally protected interstate commerce laws.

Q: Is it legal under the 2022 Indiana law for a woman to use telemedicine, perhaps video chatting with a doctor in another state, to obtain a prescription for abortion pills that can then be mailed to her?

A: Well that is again a good question, but for some years Indiana law has forbidden telemedicine to be used for anything to do with abortion. Until the law last year, a physician had to physically be present in order to administer mifepristone. Now if and when the law goes into effect, patients must physically cross state lines out of Indiana into a state, such as Illinois or Michigan, that does allow in-person care or telemedicine abortion. The patient would have to also take the medications in that state, technically.

Many will find travel to a legal state impossible to accomplish and will turn instead to self-managed abortion, via mail order medication, which can be safe to do and is effective in almost all cases.

Q: Are self-managed abortions, or by taking the pill, safe for all pregnant women?

A: It is not. There are some who should not self-manage an abortion. Those who are more than 10 to 12 weeks pregnant should not. Anyone who has a bleeding disorder. And those who have ectopic pregnancies, or outside-the-womb pregnancies, should not self-manage abortion.