Mail-in abortion pills gain traction as more states restrict access

In Aid Access’ first year of operation, 21,000 American women contacted the online organization launched in March 2018 that offers abortion pills internationally. Requests came from all over the country ⁠– especially from states where abortion is strictly regulated.

After a series of states passed bans or limits in recent weeks, pushing the abortion debate in the United States to a fever pitch, abortion rights advocates said those numbers could climb.

In 2019, more than a dozen states passed or attempted to pass more restrictive abortion laws. Alabama, Georgia, Kentucky and others have decided to prohibit abortion when a fetal heartbeat is detected, that is, within six weeks of a pregnancy. Georgia’s bill allows exceptions for rape and incest, but Alabama’s does not.

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Francine Coeytaux, co-director and co-founder of Plan C, a website aimed at helping women understand abortion pills, said views on her site skyrocketed after the Alabama Senate passed his bill in May. Plan C has a report card ranking online abortion pill suppliers based on shipping time, doctor oversight, and product quality.

“When the law was passed in May, Alabama law, the next day we had a 1,600% increase on our ballot,” Coeytaux said. “We have reason to believe that sales in the United States last year of abortion pills were probably in the hundreds of thousands.

What are abortion pills?

Medical abortion, also known as abortion with pills, was approved by the Food and Drug Administration in the United States in 2000. The two pills used are mifepristone and misoprostol; the first stops the growth of the pregnancy, and the second empties the uterus.

Medical abortion before eight weeks gestation accounted for 24.6% of all abortions in the United States in 2015, according to the latest figures from the Centers for Disease Control and Prevention. The FDA said taking the combination pill in the first trimester has a 95% to 99% success rate.

Abortion pills are different from birth control pills, which are a form of birth control. They are also different from Plan B, an emergency contraceptive that works to prevent pregnancy when taken within 72 hours of unprotected sex.

Abortion with pills has proven to be a relatively safe and easy option during the early stages of pregnancy, according to the FDA. Still, the agency imposed restrictions by limiting distribution to vendors with specific certifications. Some states require in-person administration of the pills, which hinders access within more rural communities.

“Medical abortion has an extensive safety record, and evidence suggests that the restrictions placed on it by the FDA are unwarranted,” said Megan Donovan, senior policy officer at the Guttmacher Institute. “Medical organizations have called for the lifting of federal restrictions on medical abortion.”

Ingrid Skop, a San Antonio-based OB-GYN and president-elect of the pro-life American Association of Obstetricians and Gynecologists, expressed concern that women with ectopic pregnancies are obtaining abortion pills from providers. not meeting FDA criteria.

“The first pill does nothing to end a tubal pregnancy, and tubal pregnancies rupture the tube,” Skop said. “A woman who orders it online without the help of a doctor will have no idea if she has an ectopic pregnancy.”

Elisa Wells, co-founder and co-director of Plan C, said the reasoning behind restrictions on this method of abortion is political, not medical.

“It’s a very safe procedure that could help people,” Wells said. “There’s no medical reason why it can’t be more widely available than it is outside. It’s purely political at this point. People need to know that these pills are so safe .”

What are the disadvantages ?

Plan C’s website traffic has grown significantly in recent years, Wells said.

It’s not just the wave of restrictive abortion bills forcing women to pursue other options, but a constant legislative effort to limit access, she said.

“The more people are restricted, the more likely they are to try to self-manage an abortion,” said Gretchen Ely, an associate professor at the University at Buffalo who specializes in access to abortion and contraception. “So instead of it being a pre-Roe situation with things, they’re going to look to deal with it with medication. More often than not it will be unsupervised.”

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Ely said more women turning to unsupervised ways to manage their own abortions is a concerning trend. It is far better, she says, for women to have abortions with the advice of medical professionals.

Online medical abortions can put women’s lives at risk, especially those in rural areas where medical facilities are limited, Skop said.

“We consider this to be a human rights issue because the fetus is a living human being,” Skop said. “Rural women who are mainly targeted by this, they are not close to a good hospital. We run the risk with these mail order abortions of increasing the mortality rate of the procedure.”

The FDA advises against buying abortion pills over the Internet, as it would circumvent FDA requirements.

Supporters of a Massachusetts legislative bill, called the "egg law" by supporters, wear pink shirts, while opponents of the bill wear red shirts as they listen during a public hearing at the Statehouse in Boston on June 17, 2019.

In March, the FDA sent a warning letter to Aid Access for shipping drugs that the agency deemed “mislabeled and unapproved.” Aid Access founder Rebecca Gomperts, a doctor based in Austria, hit back, saying the services she provides are needed by people who face barriers to clinical abortion.

Other barriers, experts say, include lack of internet access and payment and shipping issues.

“You have to figure out how to pay online,” said Carol Sanger, reproductive rights expert. “There are details that might make it less smooth than you think. And then where are you going to have it delivered? You have to figure out where you’re going to have it sent. Could your husband open it?”

What are the implications?

Wells and Coeytaux conducted a study testing the reliability of online abortion pill suppliers. They received the pills from 18 websites and concluded that it was possible to order abortion pills online. Most of these sites are not monitored. The Plan C report card lists only one online provider ⁠ – Aid Access ⁠ – which is supervised by a physician.

People need accurate and complete information to ensure safe medical abortion, said Donovan of the Guttmacher Institute.

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“What’s important is that people always have access to the information they need to pursue medical abortion and self-managed abortion safely and effectively,” Donovan said.

The legal consequences of self-managing an abortion with pills are unclear, Sanger said. It’s also unclear how prosecutors would know a woman took the pill – they should be able to track the mail order.

The ability to buy abortion pills online, Sanger said, gives women more power to make their own abortion choices.

“The existence of the pills and the fact that you can order them shows how much power has passed into the hands of the women themselves,” Sanger said. “And that’s a huge, scary change for those who oppose abortion.”

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