The pandemic is helping abortion rights advocates in the United States achieve a long-standing goal: making it easier for women to use the pill to end a pregnancy for up to 10 weeks.
Federal and state regulations have restricted access to “medical abortion” since the Food and Drug Administration approved it two decades ago. Nonetheless, use of the two-drug regimen has steadily increased, accounting for at least 40% of all abortions, even as the national abortion rate has fallen to historic lows, the data shows.
Before the coronavirus made seeking in-person medical care risky for patients and providers, efforts were underway to expand access to abortion pills through telemedicine and mail-order pharmacies. Today, these efforts are accelerating and multiplying because suddenly a divisive political issue is also a public health issue.
“For patients seeking an abortion, urgent changes to current protocols are needed to ensure that patients can continue to obtain this urgent treatment while limiting the transmission of infection,” 11 leading reproductive health experts wrote last month in the journal Contraception.
The group, led by obstetrician-gynecologist Elizabeth Raymond, proposed reducing in-person clinic visits by eliminating ultrasounds and other tests that research shows are not necessary for safe and effective medical abortion.
Planned Parenthood Southeastern Pennsylvania, which adopted the no-test approach in mid-March, quickly saw a change. Although the total number of medical and surgical abortions remained at around 800 per month, the proportion of those using pills rose from 55% before the pandemic to 65% today.
“We wouldn’t offer it if he wasn’t sure,” said Dayle Steinberg, president and CEO of the southeast Pennsylvania branch. “The pandemic shows us that we have to be agile and adapt.”
A bit of background: Medical abortion starts with a pill called mifepristone, which blocks a vital pregnancy hormone. This is followed 24 to 48 hours later by at least two misoprostol pills, which induce contractions. (Misoprostol is also used to treat stomach ulcers.)
In 2000, when the FDA made the controversial decision to approve mifepristone, it imposed strict safety requirements. The drug can only be dispensed by specially certified health care providers and only in clinics, hospitals and doctor’s offices – not in pharmacies like most prescription drugs.
Medical societies and public health experts have called on the FDA to remove the restrictions. Physician Jane E. Henney, commissioner of the FDA when mifepristone was approved, added her voice last year. Last month, Democratic senses Elizabeth Warren and Patty Murray did the same, calling for a reassessment “in light of the growing coronavirus pandemic.”
The FDA has not budged, although its own review indicates that “medical abortion has been increasingly used as its efficacy and safety have become well established by research and experience, and serious complications arise. have been found to be extremely rare”.
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Lawyers were not deterred by the FDA’s inflexibility.
Over the past year, Gynuity Health Projects — a New York-based nonprofit that Raymond joined in 2010 — expanded its FDA-approved telemedicine medical abortion study from five states to 13. It lets women have video conferences with board-certified doctors and then have them ship the pills to take home.
Yet Gynuity’s TelAbortion has served less than 1,000 women over more than three years. That’s partly because the FDA requires all study participants to have an initial in-person visit and ultrasound to ensure they’re not more than 10 weeks pregnant.
Studies have shown that an ultrasound is not necessary; only 1% of women cannot accurately remember the date of their last menstrual period, and medical abortion still works for the vast majority of them. Other parts of the typical medical abortion protocol — a pelvic exam, blood work, and a return visit to confirm termination — are also unnecessary, the research found.
That’s why Raymond and his 10 colleagues wrote the article on contraception, which laid out a protocol for evaluating, treating, and monitoring patients in a way that would circumvent but not violate FDA rules.
“Although FDA restrictions on mifepristone may require patients to come to the abortion center to obtain the drug, this protocol would allow all other parts of the medical abortion process to be carried out without no face-to-face meetings,” they wrote.
“Nothing like an epidemic to accelerate innovations,” Raymond said in an interview.
The enemies of abortion denounce these innovations as endangering women’s health. So far, 18 states have enacted various laws to prohibit the use of telemedicine in medical abortion. More recently, several states have attempted to ban all abortions under pandemic emergency orders restricting elective medical procedures.
While the political divide is wider than ever, even abortion rights activists disagree on the level of medical support women seeking medical abortion need or how best to provide it.
Many international websites ship abortion pills – without a prescription or medical supervision – to women who “self-manage” the abortion in secret. Acknowledging that the Internet makes these countless abortions “virtually unstoppable,” public health researcher Elisa Wells co-founded Plan C, a website with a “report card” that rates these websites on product quality, price, and price. delivery time.
READ MORE: Do-it-yourself abortion not driving lower rates, analysis finds. But that could change.
In early March, as the pandemic worsened, Plan C took another step to help women self-manage: it asked doctors across the country to register with one of two manufacturers of mifepristone FDA approved so they can get pills to send to women in their homes.
FDA regulations state that mifepristone must be “dispensed” within a facility, but Plan C maintains that distribution is different from delivery.
“Most doctors read [FDA regulations] say the pills can’t be mailed out,” Wells said, adding that a handful of doctors have joined the new initiative. “We do not agree. “
Aid Access, a mail order abortion pill service overseen by Dutch physician Rebecca Gomperts, has already received a cease and desist order from the FDA.
Gomperts created Aid Access last year using the model of her first abortion pill service, Women on Web, which serves women in countries where abortion is illegal. Basically, the pregnant woman consults the prescribing doctor online and then receives a script to email to an Indian company that ships the pills. The instructions explain how to use the medications, what to expect, and when to see a doctor if you have a problem.
Although Gomperts did not respond to a request for comment, she was recently quoted in The New York Times as saying the pandemic has fueled demand, with around 3,000 women seeking Aid Access assistance since late March.
As for the FDA, Gomperts has a lawsuit against the agency pending in federal court. The FDA, she argues, is trying to deny the constitutional right to abortion.
“Dr. Gomperts has standing to assert the constitutional rights of his patients who seek medical abortions…in the United States,” his legal filings state.