SUBWAYEDITING THAT allowing women to terminate pregnancies at home for up to ten weeks after conception has transformed abortion care in many countries. Data is patchy, but it is believed that more than two-thirds of abortions in northern European countries and 90% in India occur this way. The United States, however, has lagged behind. Restrictions imposed by the Food and Drug Administration (FDA) since drugs were approved for this purpose in 2000 means that only about 40% of abortions in the United States are chemically induced.
That is starting to change. in december the FDA lifted its most onerous requirement, that women pick up the first of two drugs used to end pregnancies from a clinic or doctor’s office in person. This made permanent a loosening of the FDA introduced during the pandemic. Women can now be prescribed mifepristone, which blocks the hormone progesterone that allows pregnancy, after an online consultation, and receive it by mail. A second drug, misoprostol, which causes the uterus to contract and expel the fetus, is taken several hours later, has multiple uses, and is available by prescription.
The advantages of medical abortion are many. Research suggests that it is largely safe. In conservative states with few abortion clinics (six states have only one), it is particularly beneficial to eliminate the need for women to travel, often long distances, to attend clinic appointments. Getting prescription abortion drugs this way is also cheaper than going to a clinic, a big plus in a country where federal money can’t be used to pay for abortions. In a clinic, the cost of a medication abortion ranges from $500 to $800. Buying the pills from one of the growing telemedicine startups costs around $200.
Medical abortion may also have the potential to douse the flames of America’s abortion war. Increasing its use is likely to reduce the number of abortions performed later (surgically) in pregnancy, the kind that give anti-abortionists their most lurid and powerful campaign images.
The successes of the anti-abortion movement in the United States will limit the impact of FDAThe action of, however. About 19 states have laws that require a doctor to be present when mifepristone is taken. In December, Texas introduced harsh jail sentences and a $10,000 fine for anyone who prescribed abortion drugs via telemedicine. In all, 15 states introduced bills restricting medical abortion last year; nine of these were enacted. Women in many parts of the country will still have to travel across state lines if they want an abortion.
But removing the requirement to be in person will make things easier for them. Lauren Dubey, a nurse and co-founder of Choix, a sexual and reproductive telehealth startup that offers asynchronous care (dispensing with the need for a live consultation), says a woman can order the pills from an address in a state where this is legal. and travel when you can, without having to keep an appointment. She adds that allowing women to order pills by mail will free up capacity at brick-and-mortar clinics for those who need in-person care: women whose pregnancies are past 10 weeks, for example, or who want to keep their abortion. secret from your partner or parents.
If the Supreme Court overrules Roe vs. Wade this year, as many hope when a case related to Mississippi’s ban on most abortions after 15 weeks of pregnancy is ruled on, the benefits of abortion-by-mail will be even more apparent. Almost half of the states in the United States would ban most abortions if Roe he was abandoned.
Abortion rights activists are working to raise awareness that abortion medications are a safe option. Some stress that it’s available even when it’s not legal: Aid Access, a Europe-based charity, prescribes and ships the drugs to women in any state. It has seen a surge in demand from Texas since most abortions were banned there. Women can also buy the pills directly from pharmacies abroad. Yes Roe is nullified, it is likely that more women will obtain abortion medications in this way, whatever the FDA it says. ■
Correction: The original version of this article suggested that misoprostol is available in the United States without a prescription. It is not. This has been fixed.
This article appeared in the US section of the print edition under the headline “It’s Easier.”