FDA Temporarily Allows Abortion Pills to Be Shipped Through Mail

On April 12, the Food and Drug Administration (FDA) announced that it would temporarily halt the enforcement of a regulation requiring abortion medications to be administered physically in person by a clinician.

In a letter to two organizations representing reproductive health physicians, the FDA states it would “exercise enforcement discretion” in its requirement that the first of two drugs needed to abort an early pregnancy be given in a clinic.

With the FDA’s permission, research has been underway to prove that providing women seeking abortions with a telemedicine consultation, and having the pills mailed to them, are safe and effective. Recent research conducted over the course of the pandemic also discovered similar results—finding that abortion medications are not only safe and effective at terminating early pregnancies, but can prevent a patient’s exposure to COVID-19.

However, although the FDA regulates medications to terminate pregnancies, it doesn’t guarantee access to the medication in your state. And throughout the pandemic, access to abortion has been challenged nationwide, with a slew of states like Ohio and Tennessee trying to push through anti-abortion legislation.

Aziza Ahmed, JD, professor at the Northeastern University School of Law in Boston, tells Verywell that access to abortion through telemedicine is subject to the laws of each state. “The FDA regulates abortion pills, and then the states regulate access to abortion pills once it’s made available to a person,” Ahmed says.

Medication Abortion Restrictions

In 2000, the FDA approved the use of mifepristone, a nonsurgical method to terminate a pregnancy in the first ten weeks of pregnancy. Mifepristone is used in combination with misoprostol, another drug, to end early pregnancies and treat miscarriages. In most states, mifepristone must be administered in the physical presence of and by a clinician or physician. However, because of the pandemic, the FDA has uplifted this requirement for the time being. 

Near the end of President Donald Trump’s tenure, the Supreme Court granted his administration’s request to reinstate rules requiring people to travel to health clinics in order to pick up abortion pills, whether the patient was being evaluated in person or through telehealth.

And unfortunately, state-level restrictions have only made accessing medical abortion more fraught. Currently, 19 states, including Alabama, Kentucky, and Wisconsin, prohibit the use of telemedicine to prescribe medication for abortion. This means that a physician or clinician providing a medication abortion must be physically present to administer mifepristone. 

32 states require that the person administering the abortion medication be a physician. Some of these states include Arkansas, Florida, Georgia, Pennsylvania, Texas, and Wyoming.

In states that restrict telemedicine services for abortion, Ahmed says it disproportionately impacts women of color. “Primarily Black and Latina. This is because these are the women who have trouble accessing abortion already,” Ahmed says. “People have to pay for abortions out of pocket in many states and so, there’s already many barriers.”

According to Rachel Fey, vice president of policy and strategic partnerships at Power to Decide, one of the barriers to abortion is access to a clinic that provides abortion services. According to the Guttmacher Institute, 89% of counties in the United States did not have a clinic, hospital, or physician’s office where abortions are performed nearby. “I think we have learned in this pandemic how important it is to have telehealth options available to help compensate for barriers of people living in rural areas,” Fey tells Verywell.  

Research studies have tested the efficacy and safety of mifepristone and misoprostol, finding both to be safe and effective through an estimated 63 days estimated gestational age. “It’s [medication abortion] the safest method to do it,” Lynn McClelland, JD, MPH, law lecturer and reference librarian at the University of California Los Angeles, tells Verywell. 

Access Challenges

One of the barriers to abortion is time. “It [mifepristone] is very time-limited,” McClelland explains. “You really need to do it in the first nine weeks.” For people traveling across state lines, it could add another day. 

“Travel becomes a problem when you don’t have the money or means to travel or the fact that even in the COVID pandemic moment, we’re all trying to avoid travel and exposure to lots of people,” Ahmed adds. 

But still, some states continue to restrict access. “Several states still restrict telehealth care for abortion care, which is sort of not following the science when it comes to what’s safe and effective, and what people need as part of their full reproductive health care,” Fey says. 

While the FDA lift is only temporary, reproductive health advocates and experts hope that abortion medications will be available post-pandemic. “It’s our hope that states will make abortion care via telemedicine as available as they possibly can,” Fey says. “That’s just good medicine and it’s following the science.”