European doctor prescribes abortion pills to US women over the internet – but FDA is watching

Necolie remembers taking the pregnancy test in the bathroom and then throwing it at her husband. “I won’t do it again,” she said.

By then, in late 2018, her husband had been unemployed for three months. Necolie, who lives on the Florida coast and asked that her full name not be used to protect her privacy, was borrowing money from friends so she could drive her three children to school. During her last pregnancy, she had developed severe liver disease and had to be hospitalized.

Necolie loved being a mother but knew she wanted, and perhaps needed, to terminate the pregnancy. “It was really hard to come to this, especially as a Republican voter. … I was a Catholic. I just didn’t believe it for anyone, let alone myself.

Necolie found a clinic in Tallahassee, about three hours away, that would accept her health insurance, but she had to pay $600 upfront for the abortion and then submit the receipt to her insurance company for reimbursement. “There was no money to go out there and do that,” she said. Necolie sat down at her computer and started looking for ways to get an abortion at home.

Necolie lives on the Florida coast.BNC News

On abortion-themed message boards and subreddits, she discovered pharmacies overseas that were selling abortion pills: the drugs mifepristone and misoprostol which, since 2000, have been available in the United States as an alternative to abortion. surgical abortion for women under 10 weeks. Pregnant. In the United States, these abortion pills are approved but heavily regulated by the Food and Drug Administration and can only be dispensed by medical professionals who agree to store the drugs and sign a waiver guaranteeing emergency care to women who need it.

But online, dozens of websites offer the pills for less than $100 to over $500. Some make dubious claims about “painless” and “100% working” abortions.

As states such as Alabama, Mississippi, Ohio and Georgia pass bills restricting access to abortion, and abortion remains an unaffordable option for many women like Necolie, experts expect more American women to turn to these websites for alternatives.

“As access to abortion in clinics becomes increasingly limited, I anticipate more people will seek out options, including online options,” said Dr. Daniel Grossman, professor of obstetrics, of Gynecology and Reproductive Sciences at the University of California, San Francois.

But by selling unregulated abortion pills, these websites are breaking US law, according to the FDA, which last year raided the home of a New York woman who was shipping abortion pills. The FDA declined to comment.

Another fight is going on between the FDA and Aid Access, an organization that was started in April 2018 by a Dutch doctor, based in Europe – and whose website Necolie found while searching online for abortion pills. Doctors in the group prescribe abortifacient drugs for $95 — or free, if in financial need — then send the prescriptions to a pharmacy in India, which mails them to the United States. Access to help differs from many other online abortion pill providers in that it is managed by a physician, Dr. Rebecca Gomperts.

On March 8, the FDA sent Gomperts a warning letter, notifying the organization that it was violating US law and ordering it to “immediately cease” its sale of “mislabeled and unapproved new drugs.” The letter notes that the specific brand of mifepristone and misoprostol sent to Aid Access patients has not been approved by the FDA. The FDA approval process involves inspecting a manufacturing facility and testing its products.

Gomperts told NBC News that she would not comply with the FDA’s warning: “I will not stop helping women who need my help.” She also disputed the claim that she was selling drugs, since she sends her prescriptions to an independent pharmacy. In a letter to the FDA, Gomperts’ lawyer argued that because abortion is restricted in the United States, “women have been forced to try to exercise their right to medical abortion via the Internet.”

An abortion option

Gomperts made a name for herself in the 1990s when she began performing abortions on a boat in international waters for women who lived in countries where abortion was illegal, such as Ireland. In 2006, when abortion drugs were more widely available, she launched Women on Web, a “telemedicine support service” that prescribed mifepristone and misoprostol.

At first, Gomperts didn’t think women in the United States would need his services, since abortion is legal nationwide. But she said she soon began receiving advocacy letters from American women asking for help terminating their pregnancies, so she launched Aid Access to serve Americans directly.

Dr Gomperts
Dr. Rebecca Gomperts in Amsterdam.BNC News

In its first year, Aid Access received about 21,000 requests for abortion medication, according to Abigail Aiken, assistant professor of public affairs at the University of Texas at Austin, who analyzed Aid Access data. . Requests came from all states and the District of Columbia. In 2018, 2,581 women received Aid Access prescriptions for abortion drugs, according to a statement from Gomperts’ lawyer.

In her Amsterdam office, Gomperts told NBC News that most of her patients come to see her because they can’t afford abortions where they live. Others say they face domestic violence and cannot get to a clinic safely. The median cost of an abortion, at 10 weeks or less, is around $500, according to the Guttmacher Institute, a think tank that supports abortion rights. In many states, Medicaid and some insurance companies are only allowed to cover abortion if the patient’s life is in danger or if the pregnancy results from rape or incest.

There are no detailed data on the number of “self-induced” abortions by American women, Grossman said. One of his studies, published in the journal Contraception, found that up to 7% of abortion patients in Texas had attempted to terminate their pregnancies before going to a clinic. A 2014 national survey found that approximately 2% of abortion patients had attempted to self-induce at some point in their lives. A 2018 article concluded that many choose to self-manage abortion due to “barriers to accessing clinics”, although some prefer “the convenience, privacy and familiarity of one’s own home”.

Women who order abortion pills online do so at certain risks. It is illegal to order prescription drugs online, although an FDA spokesperson confirmed that the agency “generally does not take enforcement action against individuals who purchase drugs online for personal use.” . The FDA also notes that prescription drugs purchased online are not regulated by the FDA and therefore could be contaminated or counterfeit.

The legality of voluntary abortion itself is complicated and varies by state. Since 2000, at least 21 people across the United States have been arrested or imprisoned for allegedly terminating a pregnancy or helping someone they know terminate a pregnancy, attorney Jill E. Adams said. and executive director of If/When/How, an organization focused on reproductive justice.

Six states have laws against self-managed abortion. (Idaho’s law was declared unconstitutional by the 9th Circuit Court in 2015, but it is still in effect.) Thirty-eight states have fetal homicide laws. In other states, Adams said, prosecutors have used a patchwork of outdated criminal laws, some dating back to the 1800s, to charge women with crimes such as “concealment of a birth”, “inappropriate disposal of fetal remains” or “illegal practice of medicine”.

Some health care providers worry that women who abort are putting themselves at risk, in part because they don’t have a doctor to oversee their care: check on their pregnancy status and screen risk factors, such as an ectopic pregnancy. . Serious complications from medical abortion occur in approximately 0.3% of cases.

Aid Access informs patients that medical abortions and miscarriages look alike, so if a patient needs to go to hospital due to complications, “you can tell the doctors you think you may have had a miscarriage.”

Gomperts said she was not aware of any deaths or serious complications among her patients.

“I was afraid to go to my doctor”

Necolie, the mother of three from Florida, found Aid Access and responded to its online survey, which asked about her medical history and proximity to emergency medical care. She paid the required $95 by bank transfer and then waited for the pills to arrive. She wasn’t sure what she had done was legal. “I just sort of automatically assumed they were operating in a gray area,” she said.

When she received the drug, she induced the abortion by taking the mifepristone pill and then, 24 hours later, by taking four misoprostol pills.

“Literally, is this going to kill me? she said she wondered. “Is this medicine legit? Is this the real deal?” Necolie took hot showers to ease the pain. Her husband microwaved bags of rice for her to rest on her stomach cramps.

The next day, Necolie thought about going to a doctor to get checked out, because of the amount of blood she was losing, but she decided against it and the bleeding stopped.

“Because I had gotten the medicine in a kind of gray area, I was afraid to go see my doctor,” she said. “I should have been able to go see a doctor.”

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