Access to mifepristone, one of the drugs taken for a medication abortion, has been politically fraught since the drug was approved more than 20 years ago. Mifepristone is regulated under what’s called a risk evaluation and mitigation strategy, or REMS — a designation generally reserved for drugs that carry a high risk to patient safety. As such, it can be dispensed only in clinics, medical offices and hospitals; only by, or under the supervision of, a specially certified doctor or other medical provider; and only to patients who have signed an F.D.A.-approved patient agreement.
For years, reproductive health experts have urged that the access requirements for mifepristone be permanently lifted, arguing that there are no significant safety reasons for a patient to get the pills in person from a doctor’s office when she is likely to take them, and experience the abortion, after she gets home. The rule places an especially great burden on low-income women, who may struggle to get to an abortion clinic, and those in areas with limited access to abortion providers.
In April, the F.D.A. said that for the duration of the pandemic, it would stop enforcing the requirement that mifepristone be dispensed in a medical clinic. That paved the way for telemedicine start-ups like Hey Jane in New York, California and Washington; Choix in California and Illinois; Just the Pill in Minnesota and Montana; and Abortion on Demand in many other states to mail abortion drugs to patients after a consultation via telemedicine.
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 medication abortion by mail. Dr. Gomperts consults with patients online from her office in Austria, writes a prescription and provides instructions on how to request the pills from a pharmacy in India — a process that generally takes up to three weeks. The cost, including shipping, comes to $110. Patients who cannot afford that amount are asked to pay what they can.
While importing drugs from abroad is illegal in most cases, the F.D.A. typically does not go after individuals who purchase medicines online for their personal use. And though a few states — South Carolina, Oklahoma, Idaho and Nevada — explicitly criminalize self-managed abortion, Texas does not outlaw terminating one’s own pregnancy, and S.B. 8 exempts abortion patients in the state from being sued. (People in any state seeking legal advice on these matters can consult the hotline run by the group If/When/How.)
Yet even more important than the access to medication abortion afforded by Aid Access may be what Dr. Gomperts’s move signals to health care providers in America. Indeed, some reproductive rights experts argue that not only can American health care providers follow her lead and prescribe abortion pills in advance — they have a responsibility to do so. Doing so would be just one way of helping patients access care, but it could be significant.
“What I’m saying to clinicians is, if you believe people should be able to have an abortion when they want one and that early abortions can be safely self-managed with pills, then understand that it’s in your hands to make that happen,” said Francine Coeytaux, a co-founder of the advocacy group Plan C, which has worked to raise awareness about the safety of self-managed abortion and to educate the public about how to acquire abortion pills online. “I think many of them are now realizing they can do this — that it’s legal and within their scope of practice.”