Access to mifepristone, one of the drugs taken for medical abortion, has been politically difficult since the drug was approved over 20 years ago. Mifepristone is regulated by what’s called a Risk Assessment and Mitigation Strategy, or REMS – a designation typically reserved for drugs that pose a high risk to patient safety. As such, it can only be issued in clinics, doctor’s surgeries and hospitals; only by or under the supervision of a specially certified physician or other medical care provider; and only to patients who have signed an FDA-approved patient agreement.
For years, reproductive health experts have insisted that the conditions for access to mifepristone be permanently lifted, arguing that there are no significant safety reasons for a patient to obtain the pills in person from from a doctor’s office when she is likely to take them, and experiences abortion, after returning home. The rule places a particularly heavy burden on low-income women, who may have difficulty getting to an abortion clinic, and those in areas with limited access to abortion providers.
In April, the FDA said that for the duration of the pandemic, it would stop enforcing the requirement that mifepristone be dispensed at a medical clinic. This paved the way for telemedicine start-ups like Hey Jane in New York, California and Washington; Choice in California and Illinois; Just the pill in Minnesota and Montana; and Abortion on Demand in many other states to send abortion drugs to patients after a telemedicine consultation.
Yet, in the 19 states that require a clinician to be physically present with the patient when administering mifepristone, Aid Access remains the only option for physician-supervised medical abortion by mail. Dr. Gomperts consults patients online from his office in Austria, writes a prescription and provides instructions on how to request the pills from a pharmacy in India – a process that typically takes up to three weeks. The cost, including shipping, is $110. Patients who cannot pay this amount are asked to pay what they can.
Although importing drugs from abroad is illegal in most cases, the FDA generally does not go after people who buy drugs online for personal use. And although a few states – South Carolina, Oklahoma, Idaho and Nevada – explicitly criminalize self-directed abortion, Texas does not prohibit termination of one’s own pregnancy and SB 8 exempts aborted patients. of the state to be prosecuted. (People in any state who want legal advice on these matters can visit the hotline operated by the If/When/How group.)
Yet what Dr. Gomperts’ decision signals to healthcare providers in America is even more important than the access to medical abortion offered by Aid Access. Indeed, some reproductive rights experts argue that not only American health care providers are following his lead and prescribing abortion pills ahead of time – they have a responsibility to do so. It would only be one way to help patients access care, but it could be important.
“What I’m saying to clinicians is if you think people should be able to have abortions whenever they want and that early abortions can be safely self-managed with pills, then understand that’s between your hands that it will happen,” said Francine Coeytaux, co-founder of advocacy group Plan C, which has worked to raise awareness about the safety of self-managed abortion and educate the public on how to acquire pills. abortions online “I think a lot of them now realize that they can do it – that it’s legal and within their scope of practice.”