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Abortion Pills Now Allowed by Mail Permanently (for People in Blue States)

The FDA said people can get mifepristone by mail, but this only changes things in states that aren't hostile to abortion.

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Image for article titled Abortion Pills Now Allowed by Mail Permanently (for People in Blue States)
Photo: AP Photo/Jeff Roberson (AP)

Today, the Food and Drug Administration said that it would lift the in-person dispensing requirement for abortion pills, which opens the door for the pills to be available at pharmacies and would permanently allow people to receive them by mail, as has been permitted during the pandemic. The change has been a long time coming, but, because this is the United States, the impacts will be unequal. And notably, this will not solve the abortion crisis in red states like Texas.

The FDA approved mifepristone, a drug that stops a pregnancy from progressing, in September 2000. Up to 48 hours later, people take misoprostol, which causes uterine contractions, and the combination of drugs essentially induce a miscarriage. The regimen is FDA-approved for abortions through 10 weeks of pregnancy, as well as to treat incomplete miscarriages. But because of longstanding FDA rules, people seeking abortions previously had to get the pills in a doctor’s office, hospital, or abortion clinic, not at their local pharmacy or by mail.

Mifepristone is the only medication of about 20,000 FDA-approved drugs that people need to pick up in person but they can take anywhere they want, per the American Civil Liberties Union. The ACLU sued the FDA in 2017 over the policy and sued again, on behalf of a different group, during the pandemic. In April 2021, the Biden administration said healthcare providers could mail abortion pills for the duration of the pandemic health emergency, and US-based telemedicine sites like Abortion on Demand launched in response. (International sites serving the US have been operating in a legally murky fashion for years.)

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These restrictions, as well as anti-abortion disinformation, have limited uptake of a method that was supposed to revolutionize abortion access. Today, many people don’t know that it’s different from Plan B or understand much of anything about how it works.

Medication abortion is extremely safe, and so is letting people get it by mail or a pharmacy. In 2017, Canada was the first country to remove all supplemental restrictions on mifepristone, a change which allowed people to pick up the medication at a pharmacy. A study published last week in the New England Journal of Medicine looked at all abortions in the province of Ontario from 2012 to 2020 and found no increase in abortion-related complications.

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But the updated rules only change the status quo in mostly Democratic-controlled states: 19 states have passed laws that effectively ban providers from prescribing medication abortion via telemedicine and, well, look at the map of them.

Map of 19 States Have Policies that Restrict Telemedicine for Medication Abortion
Graphic: Kaiser Family Foundation (Fair Use)
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The map isn’t a one-to-one match of states that voted for President Trump, but it’s pretty close, and they’re mostly in the South and Midwest, where it’s already very, very hard to get an abortion, and where abortions will be almost totally banned if the Supreme Court overturns Roe v. Wade in June, as it looks likely to do. You’ll see that Texas requires the prescriber to be physically present; so no, the FDA’s move won’t help people racing to get abortions under the states’s six-week ban, and anyone who frames it as a solution for Texans is wrong.

People in these states have some extralegal options, including having friends mail them pills or ordering from Aid Access, a site run by a European doctor, which now lets people in all 50 states order abortion pills before they’re pregnant so they can have them on hand if needed. But some folks won’t want to take the risk of ordering pills outside the US medical system and pills are most effective through the 10th week of pregnancy, which is why sites like Aid Access are not a solution to abortion bans.

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“This should have always been an option for pregnant patients and we’re relieved this is now possible,” Jamila Perritt, MD, president and CEO of Physicians for Reproductive Health, said in a statement. “While this decision is a game changer, it is not the solution. Despite the FDA’s action, states across the country continue to impose medically unnecessary, dangerous restrictions on medication abortion care.”

Plus, the FDA’s long-overdue updates will no doubt result in more state-level backlash. The president of Students for Life told Politico that, in anticipation of the changes, the group was already lobbying more than 30 states on limits to medication abortion. Today’s news is a partial win, with much more work to be done in the states for access to be truly equitable.