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Abortion Pills by Mail Access Is Limited Depending on State

FDA Will Now Permanently Allow Abortion Pills by Mail — but Restrictions Exist in Some States

Photographer: Matthew Kelly

On Dec. 16, the FDA ruled to permanently lift a requirement that mifepristone, the first drug in a two-drug regimen taken for medication abortion, be dispensed in person by a healthcare professional. Now, people can get abortion pills through the mail. This comes after the agency said in April that it would temporarily stop enforcing the requirement — stated under the drug's Risk Evaluation and Mitigation Strategy (REMS) guidelines — for the remainder of the COVID-19 pandemic. However, there are still limitations depending on where you live.

How We Got Here: FDA Permanently Allows Abortion Pills Via Mail

The director of the FDA's Center for Drug Evaluation and Research, Patrizia Cavazzoni, MD, wrote in a letter posted on the American Civil Liberties Union (ACLU) website that the FDA concluded the REMS should be modified to "minimize the burden on the healthcare delivery system of complying with the REMS and to ensure that the benefits of the drug outweigh the risks."

Ahead of the temporary ruling in April, the Center for Drug Evaluation and Research had evaluated telemedicine abortion studies to determine the risk factor of medication abortion by mail during the pandemic. It felt that the studies did not show increases in safety concerns, the FDA's acting commissioner, Janet Woodcock, MD, stated in her own letter at the time. The ruling in April had offset a January Supreme Court ruling to keep the distribution restriction in place.

Colleen McNicholas, DO, ob-gyn, and chief medical officer at the Planned Parenthood of the St. Louis Region and Southwest Missouri, explained to POPSUGAR back in April that, previously, whether you had to take the first drug in the health center or doctor's office or you could instead go pick it up and then simply bring it home with you completely depended on state law. Ahead, find out more about medication abortions.

How Do Abortion Pills Work?

The FDA first approved mifepristone, known as Mifeprex, in 2000, and it is ordered, prescribed, and dispensed by a qualified healthcare provider up to 70 days — or up to 77 days in some cases — of pregnancy; the FDA decision now means mifepristone specifically can be distributed by mail in states without limitations (more on that later). Then, as approved by the FDA, a different pill, misoprostol, is taken 24 to 48 hours after taking Mifeprex in the location of your choice, meaning it can be administered at home.

How you qualify for a medication abortion pill will depend on where you live, but in terms of gestation, Dr. McNicholas explained, the FDA approved the medication through 70 days of gestation, and the medical community has since developed and supported use up to 77 days.

Dr. McNicholas said mifepristone stops a pregnancy from progressing because it blocks progesterone, one of the hormones that holds the pregnancy to the uterus. Misoprostol then causes the uterus to contract and results in cramping and bleeding that expels pregnancy tissue, which usually starts in one to four hours. According to Planned Parenthood's national website, a person may also feel the following side effects:

  • Upset stomach and vomiting
  • Diarrhea
  • Mild fever
  • Tiredness
  • Heavy bleeding with large clots
  • Dizziness

Nausea and slight bleeding may begin after taking mifepristone, though it's not common. Expelling the pregnancy tissue can usually last five hours or longer, and the cramping may persist for a few days. Planned Parenthood noted that if you don't have any bleeding within 24 hours of taking misoprostol, you should call your doctor. You'll have a followup appointment a week or two after the medication abortion, which Melissa Grant, COO of abortion and reproductive health service provider Carafem, told POPSUGAR can happen virtually (after checking in about symptoms, providers may later ask you to take a home pregnancy test to confirm a negative test result).

How Effective Is the Abortion Pill?

According to Planned Parenthood, if you are eight weeks pregnant or less, a medication abortion works about 94 to 98 percent of the time. For people who are between 10 and 11 weeks pregnant, it's about 87 percent effective. Though rare, if the abortion doesn't work and you're still pregnant, you may need additional medication or to go for an in-clinic procedure. Complications from medication abortion are also rare but could include pregnancy tissue left in the uterus, infection, allergic reaction, blood clots in your uterus, and too much bleeding. Call your doctor if you feel sick more than 24 hours after taking misoprostol.

Where Can You Get Abortion Pills?

Typically, you get these pills from a doctor's office or clinic such as Planned Parenthood or Carafem. Grant suggests using the National Abortion Federation as a resource where you can find a list of accredited providers from across the country. Some doctors will give mifepristone to you in their office and then write a prescription for misoprostol to pick up at a certified pharmacy separately, or they might have misoprostol at their disposal already and send you home with it; now it should be easier for many to get both sent via mail or through a mail-order pharmacy.

The cost varies and also depends on many factors like the facility you go to, state law, other tests you may need to get before or after your medication abortion, and insurance coverage. However, she noted that the national average for medication abortion through a private office is usually between $400 to $450. People who choose to purchase the pills virtually, she said, tend to pay a reduced cost.

The FDA's decision opens up the opportunity for a medication abortion process that is entirely done virtually, such as Abortion on Demand and Aid Access. Carafem offers video consultations, too, in some states for medication abortions. Plancpills.org offers help to finding medication abortions by state as well.

Carafem participated in the TelAbortion Study, which was sponsored by reproductive health nonprofit Gynuity Health Projects, used telemedicine for medication abortions, and sent these drugs through the mail. It completed enrollment at the end of September. "We did this primarily because we serve a large number of rural clients, particularly in the South and in the Midwest, who are traveling great distances to receive medication abortions," Grant said.

A Win, but Not a Complete Victory For Medication Abortions

"It's important that people have safe options that are respectful of their own personal needs, their own personal belief systems, if they decide that they want to have an abortion."

Though the FDA's decisions (in April, then this week) were wins for abortion access, obstacles on the state level remain. For example, on Dec. 2, Texas narrowed the window in which doctors are allowed to prescribe abortion pills from 10 weeks of pregnancy to seven weeks and specifically forbade doctors from sending abortion pills through the mail. Doing so is now a felony (note: pregnant people are not considered liable). Additionally, laws in 19 states already prohibit medication abortions from taking place virtually because they require clinicians be physically present when the medication is administered.

Both Grant and Dr. McNicholas wanted to stress that mifepristone and misoprostol used for medication abortion are not only effective but also safe. "The additional barriers do nothing to make it safer and, if anything, actually delay appointments, increase costs, and create more stress and strife for the people in the situation," Grant said.

Abortion is not an uncommon experience (the abortion rate in 2014 was one in four by age 45). The Guttmacher Institute estimates that in 2017, 39 percent of abortions were medication abortions, and it estimated that among abortions that happened within a 10-week gestation window, medication abortions accounted for 60 percent that year. CDC data revealed that 42 percent of all abortions reported to them in 2019 (629,898 total) were medication abortions.

Grant added that untended pregnancies are often complicated by financial instability and inadequate access to healthcare. "It's important that people have safe options that are respectful of their own personal needs, their own personal belief systems, if they decide that they want to have an abortion," she said. "Whether you prefer to have your abortion at home with a pill, in the clinic with medication, in the clinic with a procedure and maybe additional painkiller, these are all legal, safe options the patient themselves should be able to choose."

Image Source: POPSUGAR Photography / Matthew Kelly
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