On March 8, I received a letter from the FDA ordering my organization, Aid Access, to stop providing telemedical abortion services to women who cannot otherwise access safe abortions because of costs, domestic violence, distance or other reasons, and who do not have access to other doctors willing or able to prescribe misoprostol and mifepristone. This letter was applauded by Republican members of Congress, of whom 92 percent are male.
But I will not be deterred.
When U.S. women seeking to terminate their pregnancies prior to 9 weeks consult me, I will not turn them away. I will continue to protect the human and constitutional right of my patients to access safe abortion services.
The FDA is violating the rights of all U.S. women seeking safe abortion by preventing them from accessing necessary medications. My lawyer, Richard Hearn, has responded to the FDA’s attempt to stop me from prescribing misoprostol and mifepristone to U.S. women.
Nearly half—2.8 million—of the 6.1 million pregnancies in the U.S. are unintended. Unintended pregnancy rates are more than five times higher among low-income women. One in four U.S. women will have an abortion by the age of 45.
The services and care I provide are essential in a landscape where more and more states are dismantling access to clinical abortions through the targeted regulation of abortion providers, banning abortion care before many people know they are pregnant and outright criminalizing abortion care. Research has shown these restrictions will mostly harm women living in poverty, survivors of domestic violence and young people under the age of 18 who need abortion care.
As a physician, I have the obligation to provide medical care to people in need. To be able to provide safe abortion services to women in need, I launched the website Aid Access one year ago—and since then I have seen firsthand the urgent need for access to safe abortion care among those who cannot access it in a clinic in the United States. Last year, I prescribed 2,581 medical abortions out of 11,108 women who consulted me. The service is provided on a sliding scale fee. Most of my patients were living in poverty; more than a one in four could not afford to pay 80 Euro.
Medical abortions before 10 weeks of pregnancy are extremely safe. It is very similar to a spontaneous miscarriage. Like most women who experience a spontaneous miscarriage, women who use the abortion pills generally do not need follow up care. Medical abortions are significantly safer than childbirth (one death per 3,571 births), penicillin (one death per 100,000 prescriptions) and Viagra (one death per 20,000 prescriptions). The National Academies of Sciences, Engineering, and Medicine reported that risks are similar in magnitude to the reported risks of serious adverse effects of commonly used prescription and over-the-counter medications. Scientific research has proven that also telemedical abortions are extremely safe and effective.
Women in the U.S. have a 60-fold higher risk of death from childbirth than from a medical abortion. Furthermore, giving birth is associated with a 25 times higher risk for severe maternal morbidity than a medical abortion. Maternal mortality and morbidity are three times higher among poor and black women.
Aid Access is a harm reduction strategy. We offer safe abortion options to women who, decades ago, may have been forced to harm themselves, or risk their own lives, to end their pregnancies. Women denied a wanted abortion and who are forced to carry a pregnancy to term have four times higher risk of living below the Federal Poverty Level (FPL); are more likely to experience serious complications from the end of pregnancy, including eclampsia and death; more likely to stay tethered to abusive partners; and more likely to experience anxiety after being denied abortion.