Mail-Order Abortions Are Now Available in the U.S. What Does That Mean for American Women?

Aid Access will mail the two-drug cocktail used across the world to women in the United States.
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Positive pregancy test

A well-established abortion-by-mail provider is expanding its services to the United States, the Atlantic reported on Thursday. Women on Web, run by Dutch doctor Rebecca Gomperts, has provided remote consultations, prescriptions, and pills to patients seeking abortions since 2006. But until now, Gomperts has never operated in the U.S., fearing the powerful pro-life lobby's impact on her international service. Now, she's started Aid Access, a spinoff of Women on Web that provides American women with mifepristone and misoprostol—a drug combination widely used for early term abortions.

Here are the answers to some key questions about the use of these drugs.

What Do the Drugs Do, Exactly?

Mifepristone, also known as RU-486, blocks the hormone progesterone, which is essential to continuing a pregnancy. This induces a miscarriage. Misoprostol softens the cervix and induces uterine contractions, expelling the the contents of the pregnancy.

Are They Safe?

As long as you don't have an allergy to either medicine (extremely rare, and the reactions tend to be mild) or an ectopic pregnancy, the drugs are both safe and effective—when taken together, they work up to 98 percent of the time, and misoprostol alone can be up to 85 percent effective. There are a few potential complications, just as with any miscarriage; they include heavy bleeding, infection, or incomplete abortion (when the pregnancy isn't progressing, but the contents haven't been expelled from the uterus).

Aid Access recommends taking the drugs within an hour's distance from emergency care in case of complications. Still, studies have found low rates of adverse events across the globe. Plan C, a website with information about chemical abortion, gave Aid Access high marks in a comparison of pill suppliers.

Are They Approved for Abortion?

Mifepristone has been approved by the U.S. Food and Drug Administration for inducing abortion since 2000. Misoprostol is only FDA approved drug for preventing and treating ulcers, but it's very commonly prescribed off-label for softening the cervix before intrauterine device insertion and expelling the contents of a miscarriage. It's used across the world as an alternative to vacuum aspiration. Both the FDA and the World Health Organization recommend the two drugs used together as a safe abortion protocol (both are on the WHO's list of essential medicine). Medication abortion now accounts for a third of all abortions in the U.S.

How Does the FDA Say You Should Use Them?

In 2016, the FDA revised its mifepristone protocol. According to the new guidelines, mifepristone and misoprostol are approved for use together to end pregnancies up to 70 days' gestation (10 weeks)—the same recommendations Aid Access operates on. However, the FDA does advise against getting them online.

Where Do You Get the Drugs, If Not Online?

Mifepristone can only be dispensed by specially licensed doctors and can't be picked up in a regular pharmacy—you have to get it at a medical office. Misoprostol can be picked up at a pharmacy and should be taken 24 to 48 hours afterwards.

If the Drugs Are Already Legal, What's the Point of an Online Service?

It's cost-effective, private, and easy. Currently, not only is mifepristone not available at regular pharmacies, but it can cost up to $1,000. Plus, even though you can pick up misoprostol at a pharmacy, there have been several well-publicized cases of pharmacists refusing to honor the prescription.

It comes down to access, Gomperts told the Atlantic: Her previous service mailed abortion drugs to women in countries where the procedure was illegal, but as abortions become harder for Americans to get, her inbox has been flooded with requests for help. Before Aid Access, telemedicine services like Women on Web could provide dosages and instructions for use, but women seeking abortion had to buy their own pills from online pharmacies with little direction. Aid Access combines the two: A physician is available to talk through the procedure, and can prescribe and ship you the drugs. Also, the drugs only cost $95 (with a sliding scale for patients who can't afford it), and they show up directly at your home.

Is Buying These Drugs Online Legal?

This is fuzzy. Aid Access has a doctor prescribe you medication, which is filled at a pharmacy in India and shipped to your house. The FDA's personal import rules are a bit uneven, but, generally, it "does not object" to importation of drugs for personal use. And because abortion is such a politically volatile issue, prosecutors have charged women in different states for acquiring and taking abortifacients.