Access to mifepristone, one of the drugs taken for medical abortion, has been politically difficult since the drug was first introduced. approved over 20 years ago. Mifepristone is regulated by what is called a Risk Assessment and Mitigation Strategy, or REMS, a designation generally reserved for drugs that pose a high risk to patient safety. As such, it can only be dispensed in clinics, doctor’s offices and hospitals; only by or under the supervision of a specially certified physician or other medical provider; and only to patients who have signed an FDA approved patient agreement.
For years, reproductive health experts have urged that the conditions for access to mifepristone be lifted permanently, arguing that there is no significant safety reason for a patient to obtain the pills in person from from a doctor’s office when she is likely to take them and experience the 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 living in areas where access to abortion providers is limited.
In April, the FDA said that during the duration of the pandemic, it would stop enforcing the requirement that mifepristone be dispensed in a medical clinic. This paved the way for telemedicine start-ups like Hey Jane in New York City, 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 medication 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 is still 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 order 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 afford this amount are asked to pay what they can.
While importing drugs from overseas is illegal in most cases, the FDA does not generally target people who purchase drugs online for their personal use. And although a few states – South Carolina, Oklahoma, Idaho, and Nevada – explicitly criminalize self-administered abortion, Texas does not prohibit terminating one’s own pregnancy, and SB 8 exempts patients with underwent an abortion in the state to be prosecuted. (People in any state seeking legal advice on these matters can visit the hotline run by the If / When / How group.)
Yet even more important than the access to medical abortion offered by Aid Access may be what Dr. Gomperts’ movement signals to healthcare providers in America. Indeed, some reproductive rights experts argue that not only America’s healthcare providers are following her lead and prescribing abortion pills ahead of time – they have a responsibility to do so. This would only be one way to help patients access care, but it could be important.
“What I’m telling 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 it is in your hands. hands to make this happen, ”said Francine Coeytaux, co-founder of advocacy group Plan C, which has worked to raise awareness of the safety of self-administered abortion and educate the public on the way to acquire abortion pills online. “I think a lot of them now realize that they can do it – that it’s legal and within their scope of practice.