Abortion Is Available by Mail in 13 States; 21 Attorneys General Urge Broader Access

(Lorie Shaull / Creative Commons)

For years, anti-abortion legislators have shut down women’s health clinics through targeted regulations of abortion providers, known as TRAP laws. As a result—even before a pandemic hit the nation—many women have been forced to travel long distances to get to abortion clinics.

Now, the COVID-19 outbreak, and the need for social distancing, has made this travel more dangerous than ever.

To make matters worse, hostile state governors and attorneys general are using the crisis to try to close down the remaining clinics for the duration of the pandemic by declaring abortion a non-essential medical service—forcing women to travel even farther, sometimes across state lines, to access abortion health care. 

But abortion advocates are fighting back by calling for greater access to the abortion pill as an important way to provide safe, accessible, socially distant abortion health care to women. 

FDA Restrictions Hamper Wider Access to Medication Abortion 

When initially approved by the U.S. Food and Drug Administration (FDA), anti-abortion forces blocked easy access to mifepristone, the abortion pill, using the FDA’s Risk Evaluation and Mitigation Strategy (REMS)—a drug safety program that allows the FDA to restrict the circulation of certain medications with serious safety concerns to help ensure the benefits of the medication outweigh its risks.

Under the REMS program, mifepristone must be dispensed by a clinic, medical office or hospital under the supervision of a healthcare provider registered with the drug manufacturer.

Additionally, patients must sign a “Patient Agreement” form confirming that they received counseling on the risks associated with the medication. 

But now, women in 13 states have greater access to the abortion pill under a research exception to the REMS.

In 13 States, Abortion Pill Available by Mail

The organization Gynuity Health Projects runs a research study on telemedicine abortion called TelAbortion—which allows clinicians participating in the study to provide medication abortion care by videoconference and mail, without an in-person visit to an abortion provider.

The study is currently running in 13 states: Hawaii, Washington, Oregon, New Mexico, Colorado, Georgia, New York, Maine, Iowa, Minnesota, Illinois, Maryland and Montana. 

Gynuity Health Projects runs a research study on telemedicine abortion called TelAbortion in 13 states. (Shutterstock)

What About Those Living in States Prohibiting Abortion By Mail?

On March 30, a coalition of 21 state attorneys general led by California Attorney General Xavier Becerra sent an strongly-worded letter to the U.S. Department of Health and Human Services and its U.S. Food and Drug Administration (FDA), urging the Trump Administration to waive or utilize its discretion on enforcement of its REMS designation.

“As communities across the nation shelter in place to help prevent the spread of COVID-19, we must ensure that women can continue to safely access essential health services including safe and legal abortion,” said Attorney General Becerra.

“Forcing women to unnecessarily seek in-person reproductive healthcare during this public health crisis is foolish and irresponsible. That’s why we’re calling on the Trump Administration to remove red tape that makes it more difficult for women to access the medication abortion prescription drug.”

Additionally, the American College of Obstetricians, the American Medical Association, and the American Association of Family Physicians all support removal of the REMS on medication abortion.

Women in the U.S. have been safely and legally using mifepristone and misoprostol, also called “the abortion pill,” for medication abortion for two decades. Now, pro-choice advocates are trying to increase accessibility of the abortion pill through the mail. (Planned Parenthood)

In the meantime, women are self-managing their own abortions by ordering abortion pills online and following instructions for use available on reliable websites.

A 2017 study verified that ordering abortion pills online is simple, affordable and safe.  Many websites allow standard mechanisms for payment, including credit cards, wiring money via Western Union, bank transfers from platforms such as Transferwise, or using Bitcoin or PayPal.

The cost of the pills, including shipping, averaged about $235 for an “abortion kit” containing both mifepristone and misoprostol. Buying misoprostol (Cytotec) alone may be less expensive, but is also less effective than using both mifepristone and misoprostol: 85 percent vs. 97 percent.

In this study, all of the mifepristone pills ordered contained the expected amount of mifepristone and all of the misoprostol pills contained misoprostol. 

The organization Plan C is in the business of putting pills directly in the hands of women who need them.

Plan C maintains an updated list of safe websites from which to order abortion pills, with information about shipping time, product quality, and availability of physician oversight from each website.

The organization;s website also has information about how to safely self-manage abortion using the pills.

While self-managing abortion has some legal risks—which I’ll discuss in my forthcoming article—for many women it might be safer than traveling long distances to access abortion health care or risking further delay in securing an abortion.

And New York Attorney General Letitia James agrees.

New York Attorney General Letitia James on Thursday called on federal and local officials to ensure women continue to have access to safe abortion procedures amid the coronavirus pandemic. (The Hill)

“As the coronavirus spreads across the country and residents are asked to stay at home, the federal government should be doing everything in its power to ensure women can maintain control of their reproductive choices,” James said in a press release.

“Control over one’s reproductive freedom should not be limited to those able to leave their homes as we battle the coronavirus. Our coalition [of attorneys general] is calling on the federal government to make mifepristone more easily accessible so that no woman is forced to risk her health while exercising her constitutional right to an abortion.”

The coronavirus pandemic and the response by federal, state and local authorities is fast-moving.

During this time, Ms. is keeping a focus on aspects of the crisis—especially as it impacts women and their families—often not reported by mainstream media.

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Carrie N. Baker, J.D., Ph.D., is the Sylvia Dlugasch Bauman professor of American Studies and the Chair of the Program for the Study of Women and Gender at Smith College. She is a contributing editor at Ms. magazine. You can contact Dr. Baker at cbaker@msmagazine.com or follow her on Twitter @CarrieNBaker.