19 States Ignore Global Evidence and Move to Block Access to Abortion Pills

Despite a wealth of research that shows medical abortion at home is effective, safe, acceptable and improves access to care, 19 U.S. states are introducing laws to block access to the medication.

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Medical abortion outside of clinical settings can provide women with a safe option for early termination of an unintended pregnancy. (Robin Marty / Flickr)

At the end of 2021, the U.S. Federal Drug Administration (FDA) announced it would permanently ease federal restrictions on abortion pills. They’re allowing these drugs to be sent by mail, after a medical consultation by phone rather than requiring an in-person visit. The change has been welcomed by healthcare providers who point to the importance of providing women with safe methods in the fight to eliminate unsafe abortion and related deaths and injury. 

Along with the need to overcome obstacles created by COVID-19, so that women can safely exercise their right to choose even during the pandemic, supporters also point to the sharp increase in gender-based violence during the pandemic—with many women unable to leave their homes—as another reason why medical abortion at home is so important.

Yet, despite a wealth of research that concludes that a medical abortion at home with a consultation by phone is effective, safe, acceptable and improves access to care, 19 U.S. states are introducing laws to block access to the medication.

Medical abortion outside of clinical settings can provide women with a safe option for early termination of an unintended pregnancy, and more governments should be expanding access, rather than limiting it. 

At MSI Reproductive Choices, one of the largest providers of women’s reproductive health services in the world, we know what an important step forward at-home medical abortion is. When COVID-19 hit, several of our country programs worked closely with governments to roll out at-home abortion services, giving women greater access to safe, early medical abortion.

Now, with evidence from multiple countries, we can say with confidence: Medical abortion outside of clinical settings can provide women with a safe option for early termination of an unintended pregnancy, and more governments should be expanding access, rather than limiting it. 

This has certainly been true in countries that have been among the hardest hit by the pandemic. Last spring, Nepal was badly affected by a COVID-19 wave, which saw clinics across the country close to help contain the virus.

Fearing many would be cut off from vital lifesaving sexual and reproductive health services and turn to unsafe methods for terminating unintended pregnancies, MSI worked closely with the government of Nepal to ensure sexual and reproductive services were still available.

Interim guidelines were introduced during the first phase of the pandemic that have allowed women to access safe in-person medical abortion services and post-abortion care from the comfort, privacy, and safety their own homes. 

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MSI trains pharmacists like Dalin to provide support to women taking abortion pills. (Courtesy of MSI Reproductive Choices)

MSI Nepal’s network of midwives, called “MSI Ladies” have been a vital part of this. Since the start of the pandemic, they have travelled across mountains and valleys to reach nearly 3,000 women with medical abortion services at home. In a country where unsafe abortion remains common and only about 30 percent of women know about medical abortion, being able to access services at home is an important lifeline to safe care.

South Africa has also been particularly hard hit by the pandemic, and with lockdowns closing clinics, many women were left unable to access sexual and reproductive health services. MSI South Africa rolled out telemedicine services for early medical abortion across all nine provinces in the country and since the start of the pandemic has reached nearly 12,000 clients with at-home abortion services, including those in the most remote rural areas. Over 50 percent of abortion clients are now opting for telemedicine, and by making services available via telemedicine we’ve reached previously underserved clients with high-quality care.

In countries where stigma around accessing sexual and reproductive health services is prevalent, telemedicine is helping clients overcome the social barriers that can make accessing in-person services more difficult.

Drawing on MSI’s global expertise, we have also expanded our offer to women in Ghana. Abortion is permitted in the West African country under specific circumstances and last summer, MSI’s Ghana team started offering early medical abortion via telemedicine, including counselling, a medical consultation, ongoing medical support and referrals for women facing safeguarding risks.

Although smaller in size compared to other country projects, at-home medical abortion services are already making an impact, with more than 150 women receiving consultations, counseling and medical advice from a trained provider over the past few months as well as access to a range of contraceptive methods.

There are many reasons women opt for telemedicine—from rising COVID cases to simply living too far away from a clinic. But whatever their circumstances, thanks to telemedicine they’re now able to receive safe, supported care through this innovative program. And in countries where stigma around accessing sexual and reproductive health services is prevalent, telemedicine is also helping clients overcome the social barriers that can make accessing in-person services more difficult.

Abortion pills are safe and effective, with decades of data behind them. Unfortunately, political forces in the US continue to keep these essential medications out of reach for women who need them in the 19 states where laws ban the use of telemedicine for abortion. Similar restrictions around the world limit access for women who would benefit from this service.

Our experience from South Africa, Ghana and Nepal shows that at-home early medical abortion via telemedicine is safe and effective, and preferred by many women. Governments that are truly committed to eliminating unsafe abortion and reducing pregnancy-related deaths will let the data guide their decision-making.

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About

Sarah Shaw is the head of advocacy at MSI Reproductive Choices.