Advance provision of abortion pills is a growing trend among clinicians. The practice could short circuit the obstacle course that currently exists when trying to access medication abortion.
As legislators and courts erect higher and more daunting barriers to delay and obstruct access to abortion healthcare, public health experts are arguing for creative new ways to ensure that people who want or need to end unwanted pregnancies can get abortion pills quickly and use them safely. One of the latest strategies to emerge is advance provision of abortion pills.
“Before emergency contraception (aka the morning-after pill) became available over the counter, clinicians often gave it to patients in advance to have on hand when they needed it. Given the restrictions on abortion, we should think about this strategy for abortion pills,” said Dr. Daniel Grossman, a clinical and public health researcher on abortion and contraception at Advancing New Standards in Reproductive Health (ANSIRH) at the University of California, San Francisco.
The abortion pill mifepristone used in combination with another medication—misoprostol—can safely and effectively end a pregnancy through 10 weeks gestation. Mifepristone interrupts the flow of the hormone progesterone that sustains a pregnancy and misoprostol causes contractions to expel the contents of the uterus. These abortion medications are safer than Tylenol and easy to use.
In a recently published editorial, Grossman and two ANSIRH colleagues, Drs. Antonia Biggs and Katherine Ehrenreich, argue for advance provision of abortion pills as an option and explain how it could work in practice. They recommend that clinicians who prescribe abortion pills in advance should provide patients with information about how to take the pills and offer support and follow-up care if patients later choose to use them.
This model could significantly shorten the time between the decision to end a pregnancy and having an abortion, and short circuit the medically-unnecessary obstacle course that currently exists in many states for people trying to access medication abortion.
“Patients often face unnecessary delays in accessing abortion care—from state-mandated waiting periods to delays due to overcrowded clinics. If patients have pills on hand in advance, those delays are eliminated,” said Grossman.
Research shows many women want to have abortion pills on hand in case they get pregnant. In one national survey, 44 percent of respondents said they would be interested in advance provision of abortion pills. Those who faced barriers to reproductive health care were more likely to want pills in advance.
Advance provision may also be used as a “missed period pills,” where patients bring back their period by using mifepristone and misoprostol without prior pregnancy confirmation, said Grossman, Biggs and Ehrenreich.
Mifepristone has a shelf life of about five years, and misoprostol has a shelf life of about two years. While access to mifepristone is limited by the FDA, misoprostol is widely available in pharmacies through the United States and used alone is also safe but slightly less effective at ending pregnancy.
“There are some challenges with advance provision, including the cost of the pills and state legislation that may limit this model,” said Grossman. “But I hope clinicians will consider this option given the crisis in abortion access we are currently facing.”
The virtual abortion clinic Aid Access already provides advance provision abortion pills to people in all 50 states for a sliding scale fee up to $150. Based in Austria and run by the Danish doctor Rebecca Gomperts, Aid Access enables people to self-manage their own abortions with remote access to physicians through an online help desk for any questions.
The advance provision model gives people one more option for early abortion care in addition to in-clinic care and telemedicine abortion.
“While a future landscape of medication abortion may include telemedicine and mail-order pharmacy dispensing, advance provision may be a preferable option for those who would continue to face barriers to care,” wrote Ehrenreich, Biggs and Grossman.
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