Just before Texas’ 6-week abortion ban took effect on September 1, online medication abortion provider Aid Access began to let Texans who aren’t pregnant order the pills to prepare for a future unwanted pregnancy. This is a concept known as “advance provision,” and it’s akin to having emergency contraception waiting in your medicine cabinet before you actually need it. It’s especially helpful for people living in rural areas or in places hostile to birth control and abortion.
Now, Aid Access has quietly rolled out advance provision of abortion pills to people capable of pregnancy in all 50 states—a move that could revolutionize how people obtain and think about early abortion care in the US.
Dr. Daniel Grossman, professor of gynecology at University of California, San Francisco, and the director of Advancing New Standards in Reproductive Health (ANSIRH), told Jezebel that this model could help people access abortion earlier in pregnancy than they would otherwise if navigating layered state barriers. In 2018, Grossman published data showing that 45 percent of 7,000 people surveyed are interested in advance provision, even moreso than they are in getting the pills over the counter or online without interacting with a clinician.
“I’ve been talking about it for a few years and it’s been hard to get any traction, either among researchers or among providers,” Dr. Grossman said. “My hope is that this will spark a conversation among mainstream healthcare providers to think about how should this model be integrated and how should it be tested and be part of mainstream medicine, where we could also then advocate for insurance coverage.” He also noted that it could help familiarize more people with medication abortion. “I’m still amazed how many people don’t even know about this option or are confused between that and Plan B.”
The medications mifepristone and misoprostol have been available in the US for more than 20 years, and the combination of meds, which essentially induce a miscarriage, is FDA-approved for use through 10 weeks of pregnancy. But they are highly regulated—you can only be handed the pills in a doctor’s office, not a pharmacy, and you typically have to be pregnant in order to get them. Plus, until the pandemic hit, the FDA didn’t allow the pills to be mailed outside of a sanctioned clinical study. A Dutch physician, Rebecca Gomperts, launched Aid Access in 2018 as a humanitarian effort to help people seeking abortions in highly restrictive areas of the US, like the South and Midwest. During the pandemic, they started working with US-based providers who were newly able to mail the pills. And now they’ve expanded their services to include nationwide advance provision.
In 18 states that both permit medication abortion to be prescribed via telemedicine and where Aid Access has providers, a US-based provider will review the web consult and write the script, the patient will pay $150, and the package will arrive in a few days. In other states, an overseas provider will write the script, patients will pay $110, and get the pills from a pharmacy in India in two to four weeks. (Financial help is available for either option.)
Aid Access notes that people should contact them immediately if they become pregnant in the future so they can guide them through the process. They advise checking the expiration dates when you receive the medicines and note that most pills can be kept up to two years after receiving them.
Dr. Grossman said that, ideally, a provider prescribing these medications in advance would counsel people on how to track their period as well as on the early signs of pregnancy, and offer support to people when they plan to use the pills. It would also be beneficial to study the practice as he noted that the FDA considered data on advance provision of emergency contraception (brand name Plan B) when evaluating whether to make it available over the counter, another model he’s studied for abortion pills.
As for the inevitable criticism from anti-abortion lawmakers and activists (and some pro-choice ones) that services like this will lead to people giving pills to others seeking to terminate a pregnancy, aka “diversion”—this could be happening now. Since FDA labeling changes in 2016, patients are no longer required to take the first pill in the office; they can start the process at a time of their choosing. Since people take the pills at home, it’s possible that diversion occurs, though there’s no scientific evidence of that happening, Dr. Grossman said. And some health providers are already writing prescriptions for people who aren’t pregnant because they’re going to a country or region with limited abortion access for an extended period of time, like the Peace Corps, he said.
While one site prescribing pills in advance of pregnancy will help some people, it’s important to emphasize that abortion pills alone will not solve the access problem in the U.S. First, Aid Access isn’t covered by insurance and some might pay out of pocket for care that would be covered in a clinic. Other patients won’t learn they’re pregnant or know they need an abortion until they’re beyond the medication abortion window. For some, it’s not safe to have a miscarriage at home because of abusive partners or religious family members. And many pregnant people will still prefer in-clinic procedures because they’re over faster and allow them to get back to their jobs, schooling, or families the next day. Plus, managing your own abortion is explicitly criminalized in three states (Oklahoma, South Carolina, and, after 22 weeks, Nevada) and could be legally risky in many more.
Robin Marty, journalist and author of the Handbook for a Post-Roe America and head of operations for West Alabama Women’s Center, an abortion clinic in Tuscaloosa, offered some advice to mitigate those risks. Whether ordering on your phone or a computer, use private browsers and clear your cache afterward. Since the pills are good for about two years, people could run into trouble even for a future wanted pregnancy that ends in miscarriage or stillbirth if someone remembers you talking about ordering pills. If people want to tell trusted friends, doing so in person or over the phone are the safest options, followed by encrypted, disappearing messages on an app like Signal, Marty told Jezebel.
Overall, this move by Aid Access is a good thing, Marty said, but it will have consequences. “I have always been a huge proponent of people being able to access medication abortion as quickly as possible and before they actually need it, and Aid Access appears to be the first one who is able to make this occur [on a broader scale],” she said.
“I would definitely encourage people who are interested in this in doing this while they can,” she said. “The response to this is going to be a far more aggressive stance and [states] starting to criminalize directly any person who performs their own abortion.”
If you or someone you know needs assistance self-managing a miscarriage or abortion, you can call the Miscarriage + Abortion Hotline at (833) 246-2632 for confidential medical support, or the Repro Legal Helpline at (844) 868-2812 for confidential legal information and advice.