On 16 December 2021, the US FDA permanently lifted a major restriction on access to abortion pills. Patients will now be allowed to receive the pills by mail instead of requiring them to obtain the pills in person from specially certified health providers, an antiquated form of over-regulation that should have disappeared long ago had it not been for the anti-abortion backlash hovering around it .
The policy change means that medical abortion, authorised in the USA for pregnancies only up to 10 weeks’ gestation, will be more available to women who find it difficult to travel to an abortion provider and/or prefer to terminate a pregnancy in their homes. It also allows them to have a telemedicine appointment with a certified provider, who can prescribe the pills and send them by post.
In 19 US states, mostly in the South and the Midwest, telemedicine visits for medication abortion are banned, and other conservative states are expected to pass new laws to further curtail access to abortion. In contrast, states that have long supported access to abortion, like California and New York, are expected to increase the availability of abortion pills and provide opportunities for women living in states with restrictions on the pills to travel to a nearby state that allows them.
“The agency conducted a comprehensive review of the published literature, relevant safety and adverse event data, and information provided by advocacy groups, individuals and the applicants to reach this decision,” an FDA spokeswoman said.
The agency also said that pharmacies could begin dispensing mifepristone if they became certified by the drug’s manufacturers and if they received the prescription from a certified health provider. Reproductive health experts said they expected further details about pharmacies’ role to be worked out in the near future.
So far this year, presumably in anticipation of such a decision, six states banned the mailing of pills, seven states passed laws requiring pills to be obtained in person from a provider, and four states passed laws to set the upper limit on medical abortion at earlier than 10 weeks’ gestation.
The US Centers for Disease Control & Prevention reported meanwhile that 79% of all abortions in the USA occurred before 10 weeks’ gestation, suggesting that there are many more women who might well choose abortion pills over an in-clinic procedure if they could.
A research programme allowed by the FDA to provide telemedicine consultations and send pills by mail reported in the journal Contraception in March 2021 found that 95% of the 1,157 abortions that occurred through the programme between May 2016 and September 2020 were completed without requiring any follow-up procedure. Patients made 70 visits to emergency rooms or urgent care centres, with only 10 instances of serious complications, the study reported.
SOURCE: Boston Globe, by Rachel Rebouche, Greer Donley, David S Cohen, 22 December 2021 + VISUAL by Charlie Neibergall/Associated Press ; New York Times, by Pam Belluck, 16 December 2021