It’s Illegal to Have an Abortion Online, but Maybe It Should Be
Nearly half of all early abortions are done with just a few pills. The tablets are safe to take at home with very low complication rates. So why can’t you get them through an online doctor’s service, how can we with birth control pills and other medications?
Part of the reason is federal law prohibiting the dispensing of mifepristone, one of the essential pills, like other prescription drugs. The only way to get it is to visit a healthcare provider who is registered with the FDA for a special program. The ACLU is now suing the federal government to overturn the rule because it does not benefit patients in any way.
The rule “might have made sense back in 2000, when the drug was first approved with very little safety data in the US,” says Dr. Daniel Grossman, professor of obstetrics and gynecology at the University of California, San Francisco and director of ANSIRH. … He argued that restrictions on mifepristone only make it difficult for pregnant women to have an abortion early in pregnancy and lead to later abortions, which are more expensive, difficult and more risky (although no abortion is more dangerous than childbirth).
So why do regulations make it difficult to access the drug? Dr. Grossman says a doctor who can prescribe it to only a few patients a year will not bother with stockpiles of the drug and may not want to register for fear of being labeled as an abortion provider and targeted by anti-abortion activists. … The drug was supposed to solve the problem of abortion availability, but restrictions from the FDA and states meant the problem was still very real.
State laws make it difficult to take pills
In addition to federal laws, each state has its own abortion laws that can affect the availability of medical abortion. The Kaiser Family Foundation has a breakdown of these laws .
In some states, mifepristone is regulated differently than other pills. For example, in three states, a drug must be prescribed exactly as indicated on its label. It may not sound so bad, but it prevents prescribers from using a drug better than what was fossilized on the label – for example, if new research shows a different dosage is safer or more effective. For any other drug, providers can prescribe it “off-label” according to their clinical judgment.
In fact, in 2016 the FDA label for mifepristone was updated to include major changes reflecting how doctors already knew the drug could be prescribed: for a longer period of pregnancy, at a lower dose, and without the personal supervision of a doctor. Doctors in several states have already used the drug, but in other states they have been forced to use outdated regulations.
Some states allow telemedicine – essentially a very formal Skype call – while you’re in the clinic. It helps make the drug more affordable, but many states don’t even allow it. The relevant laws usually state that they are for safety.
Dr. Grossman called it a bluff and conducted a study to compare abortion with telemedicine versus personal medication. The study showed that side effects were extremely rare: 0.18 percent of patients involved in telemedicine and 0.32 percent of patients who were directly involved. (None of these were fatal or serious enough to warrant surgery.) The American Congress of Obstetricians and Gynecologists endorses telemedicine for medical abortion, writing that they “can be safely and effectively delivered through telemedicine with high patient satisfaction.” …
Bringing it home
But all this applies to telemedicine in the clinic. I asked Dr. Grossman if it makes sense to deliver abortion pills through an online service, as many other medicines do. (He has already noted that the side effects of abortion pills are much safer than those of other prescription drugs, including Viagra.)
“I think it’s smart,” he says. “These drugs are very safe.”
He points out that the person who orders the pills should be very confident about how long they are in the pregnancy, as the typical mifepristone and misoprostol regimen is only for pregnancies of 10 weeks or less. (The higher dosage option may be appropriate for some late pregnancies, but you should talk to your doctor about whether this is your best option.)
Services such as Women on the Internet help people in some countries purchase abortion pills over the Internet, but none currently supply pills to the United States; they focus on countries where abortion is even more difficult to do.
But if you can get instructions and pills, you can theoretically have your own abortion at home. We absolutely do not recommend that you do this. But if you’re wondering how it works, abortionpillinfo.org has information.
If you google abortion pills for something to buy, you will find all sorts of products on offer, from herbs (don’t use them) to emergency contraception (if you’re already pregnant, it’s too late). … But there are also scattered pharmacies that sell what they call genuine mifepristone and misoprostol.
New contraceptive research from the Plan C project team that provides information on medical abortion shows what happens when you order these pills. They sent the samples to the laboratory and found that all mifepristone tablets contain the correct dosage of mifepristone. Some misoprostol tablets were at a lower dosage than indicated on the label, possibly due to improper storage.
Prices ranged from $ 110 to $ 360, including shipping (the average cost of a medical abortion at a clinic is about $ 500), and delivery took three to 21 days. “Almost all the pills we ordered arrived,” the authors write. Not entirely reassuring. They have posted a list of who sent them what and for how much, although there is no way to guarantee what you get if you place your order tomorrow.
Because these drugs can be safely taken at home and a doctor who prescribes drugs away from the doctor can effectively manage your treatment, there is no reason anyone needs to travel hundreds of miles to the abortion doctor just to get them. It’s time for abortion pill laws to catch up with science.