Boxes of the drug mifepristone sit on a shelf at the West Alabama Women’s Center in Tuscaloosa, Ala., on March 16, 2022. Allen G. Breed/Associated Press, file

While Maine will soon have one of the least restrictive abortion laws in the country, providers here worry that access could become more difficult if a Texas appeals court ruling is allowed to stand.

“Maine would be really hard hit,” said Lisa Newcomb, communications director for Planned Parenthood of Maine Action Fund.

The Aug. 16 appeals court decision would ban telehealth prescriptions and mail deliveries for mifepristone, the first drug in a two-drug regimen used in almost all medication abortions. The medication should only be administered in the presence of a physician, the court ruled. The restrictions are on hold until all appeals have been exhausted, and the case could be considered by the U.S. Supreme Court this fall.

If allowed to go into effect, Newcomb said, Maine’s rural nature would create barriers to abortion care for many residents, even though abortion is legal. Maine providers rely heavily on telemedicine to serve patients who live far from clinics and providers.

“These federal court cases could have real impacts for people in Maine,” Newcomb said.

The appeals court ruling is seen as a victory by those who argue access to abortion is already too easy.

Carroll Conley, executive director of the Christian Civic League of Maine, which opposes abortion on moral grounds, said his group is “encouraged” by any actions that “save the innocent lives of the unborn.”

The Texas ruling would reverse changes the Food and Drug Administration made in 2016 and 2021 that eased some conditions for administering the drug. The FDA deemed the drug safe and effective, and abortion rights advocates argued the challenge was part of a strategy to restrict abortion nationwide. However, judges on the appeals court ruled that the federal agency “failed to address several important concerns about whether the drug would be safe.”

Slightly more than half of all abortions are medication abortions, according to national statistics. It’s not clear how many involve telemedicine care, although it has become a common practice in much of the country.

The Guttmacher Institute, which advocates for reproductive rights around the world, named Maine as one of the 10 states that would be most affected if the Texas appeals court ruling is allowed to stand. Other states that would be heavily affected include Vermont, Colorado, Indiana, Washington, Iowa, Georgia, Pennsylvania, New Mexico and Montana, it said.

Nicole Clegg, acting CEO of Planned Parenthood of Northern New England, said the case is an assault on the FDA’s authority.

“Let’s be clear: The political actors behind this lawsuit are not concerned about patient needs or safety,” she said. “They want to ban abortion, and they are using every tactic they can imagine to achieve their goal.”

The potential restriction on telemedicine prescriptions comes at the same time Maine is about to expand access to abortion under a new state law that takes effect in October.

The law that narrowly passed in July removes a long-standing restriction that banned abortions after viability – roughly 24 weeks into the pregnancy – unless the mother’s life is in danger. Now there will be no time limit as long as the abortion is deemed necessary by a physician. The law will make Maine one of the least restrictive states in the country.

Gov. Janet Mills, a Democrat, said she proposed the new law after learning of women who were forced to travel outside the state for abortions after learning late in pregnancy about severe fetal health problems that meant the babies would not survive.

Abortion rights advocates and abortion providers have said the new state law is not likely to result in many more Mainers seeking abortions because women who are pregnant beyond 24 weeks have already made the choice to keep their babies.  Abortions later in pregnancy are extremely rare and occur because of medical emergencies. About 1% of all abortions occur at 21 weeks of pregnancy or later, according to KFF, a national health policy think tank.

Conley, whose organization opposed the law, said he believes its passage means “the number of individuals outside of Maine seeking late-term abortions and those performing them (in Maine) will increase.”

Maine has seen an increased number of women coming to the state for legal abortions earlier in pregnancy – before viability – as more states have placed tighter restrictions on the procedure in the past year.

Newcomb said the number of people from out of state seeking abortion care at Planned Parenthood of Northern New England clinics in Maine, New Hampshire and Vermont has increased by 12.5% since the U.S. Supreme Court ruling overturning Roe vs. Wade in June 2022, allowing states to impose restrictions or bans. The organization provided a total of 215 abortions for patients from other states between July 1, 2022 and June 30, 2023. It provided more than 3,000 abortions in all during that fiscal year. Planned Parenthood and other providers performed 1,915 abortions in Maine in 2021, the latest year data was available, according to the Maine Center for Disease Control and Prevention.

Marisa Weil, executive director of Maine Family Planning, a Bangor-based abortion provider, said even though Maine is expanding abortion rights in state law, the idea of a national ban on abortion – either through the courts or the future makeup of Congress and the presidency – is “not theoretical.”

Abortion bans or strict restrictions on abortion are the reality in 21 states, Weil said. And that has forced many women to seek abortions elsewhere. Maine is not one of the states that large numbers of people are traveling to for abortion care, Weil said, because people doing so will reach other states in the Northeast first – such as New Jersey, New York and Massachusetts.

According to the Society of Family Planning, states where abortion remained legal after the ruling overturning Roe v. Wade saw the number of abortions increase from 74,950 in April 2022 to 80,600 in December 2022. A significant portion of the increase is attributed to women traveling from states with new restrictions to states where abortion is still legal.

For those who can travel, having to do so for an abortion can be costly and traumatic as people leave their home communities and their health care providers to obtain health care in other states, Weil said.

“The biggest harm is that many thousands and thousands of people are not able to travel at all, and are forced to keep their pregnancies even when it’s unsafe or the pregnancy is unwanted,” Weil said. “Thousands of people have had their choice taken away.”