by Megan Burbank
On Dec. 16, 2021, the U.S. Food and Drug Administration (FDA) permanently lifted a dispensing requirement for mifepristone, one of two medications commonly used in medication abortions, allowing the drug to be dispensed through the mail. At the time, many media outlets framed it as a new broadening of access to medication abortion. But the rule had already been temporarily lifted, and its newly permanent status reflects a longstanding effort on the part of reproductive health providers to make the medication available more widely. But even with the permanent rule change, access to medication abortion remains wildly varied. Here’s what you need to know.
The FDA Made It Official, but Abortion Pills Were Already Available by Mail
Numerous health care services have gone virtual since the COVID-19 pandemic began, and medication abortion is one of them. Because it doesn’t require outpatient surgery, medication abortion is one medical procedure that can be managed at a patient’s home. So while surgical abortion remained available in Washington during the State’s “Stay Home, Stay Healthy” order, medication abortion services presented one method of accessing care, while reducing the need for in-person clinic visits at a time when State mandates restricted or delayed medical procedures more broadly.
There was just one problem: A safety protocol for mifepristone, known as a Risk Evaluation and Mitigation Strategy (REMS), had required that the drug be prescribed only by certain health care providers and did not allow it to be mailed.
But in April of 2021, the FDA, under the control of the Biden Administration, stepped in and temporarily lifted the in-person dispensing requirement for mifepristone, citing the COVID-19 emergency. In a tweet, the American College of Obstetricians and Gynecologists called the change a win, writing: “This means that many patients in need of termination of early pregnancy will be able to access safe, effective mifepristone by mail, rather than having to risk avoidable COVID exposure to themselves and their clinicians.”
At the time, it wasn’t clear how long the restriction would remain lifted, but the FDA’s announcement in December made it permanent. In an explainer on the FDA’s website, the agency stated that after conducting a review of its restrictions on mifepristone, “the data support modification of the REMS to reduce burden on patient access and the health care delivery system and to ensure the benefits of the product outweigh the risks.”
In practice, this means that providers who had already been prescribing the drug remotely can continue doing so. So while the FDA’s announcement isn’t quite the major broadening of access some news outlets have made it out to be — access had already been expanded — it’s a notable development that likely wouldn’t have been possible without the pandemic and the resulting pivot to telemedicine.
Medication Abortion Isn’t Available Everywhere — but It Is in Washington State
Like many things when it comes to abortion access, medication abortion by mail, while technically legal, is still not available everywhere. But it is in Washington State, where providers have been prescribing the drugs and dispensing them via mail since the in-person dispensing requirement was first lifted.
Cedar River Clinics, which has locations in Seattle, Renton, and Tacoma, has even expanded access to medication abortion through telehealth: Patients in Yakima can now go to a satellite site for a telehealth appointment with a provider in one of the organization’s clinics and then receive their pills through the mail. Patients can also order the medications with clinician oversight through a number of online telehealth services including Hey Jane, Abortion on Demand, MYA Network, and Aid Access.
Oregon, too, has a number of online options for care, including Forward Midwifery, an online clinic that provides medication abortion services on a sliding scale.
But even with the FDA rule change, access can be tricky in states with specific restrictions on medication abortion. According to data from the reproductive health policy research organization the Guttmacher Institute, 33 states have these kinds of restrictions, which either limit who can provide medication abortion, ban medication abortion at a certain point in pregnancy, or require that a clinician be present in-person to provide care, which effectively makes telehealth treatment illegal (some states have all three restrictions.)
As with most abortion restrictions, these laws tend to disproportionately impact Black, Indigenous, and People of Color; folks who are low-income, LGBTQ+, disabled, or young; and people living in rural communities.
Alaska and Idaho are among the states with limits on medication abortion, which means Alaska and Idaho residents have access to far fewer licensed online counseling services than patients in Washington or Oregon. Of the newly available online physician-supervised services, Aid Access is the only organization that operates in those two states.
It’s also worth noting that medication abortion is typically only effective in pregnancies of up to 11 weeks from the pregnant person’s last menstrual period. That means that even with expanded access to the service, surgical abortions will remain a necessary component of abortion care.
Megan Burbank is a writer and editor based in Seattle. Before going full-time freelance, she worked as an editor and reporter at the Portland Mercury and The Seattle Times. She specializes in enterprise reporting on reproductive health policy, and stories at the nexus of gender, politics, and culture.
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