FDA Permanently Allows Mail Order Abortion Pills

The Food and Drug Administration (FDA) on Thursday removed the requirement for patients to pick up abortion medication in-person, allowing for the pill to be sent via mail.

Since April, the requirement has been lifted temporarily because of the pandemic, but the FDA decided to end the restriction entirely as the Supreme Court deliberates whether to roll back abortion rights.

Some OB-GYNs said the FDA decision is a win for abortion access as it reduces some of the current barriers pregnant people face when seeking for abortion care.

“It's an exciting advancement, when you think of the attack on abortion rights,” Jennifer Lincoln, MD, an OB-GYN in Portland, Oregon and an advocate for abortion rights on TikTok, told Verywell. “It feels like a war. And this is one battle that we've won.”

Mifeprex, the abortion pill also known as RU486, is approved for people up to 10 weeks pregnant.

A study on telemedicine abortion services during the pandemic found mailing abortion pills to be safe and effective, with potential to greatly improve abortion care access in the United States.

Making the pill available by mail order will open up access to people who may prefer medication abortion because of timing and privacy reasons, according to Jessica Shepherd, MD, MBA, Texas-based OB-GYN and Verywell's chief medical officer.

Where they live, how much money they have, insurance costs, numbers of skilled providers, race, and ethnicity can also serve as barriers to abortion care, she added.

“Being an OBGYN and talking to women about options on how to terminate, these are things that come up in conversation,” Shepherd said. “Now that women might have more access to [abortion pills], they might look at that more as an option than they have before.”

Where Does the FDA Decision Apply?

The FDA's decision technically applies across the country, but individual states can pass legislature banning access to abortion pills.

According to Axios, 19 states have banned or restricted mailing abortion pills or prescribing them via telemedicine visits.

Some pro-life organizations predict that more states will follow in placing restrictions on medication abortion or mail order access, The New York Times reported. On the other hand, legal experts said that pro-choice advocates will find ways to make abortion pills accessible to people in more states by filing law suits against those that prohibit telemedicine visits for abortions.

Lincoln said that unfortunately the FDA decision doesn't help people in states that have restrictive abortion laws, such as Texas.

“They could go across state lines and have it mailed there. But as we've seen in Texas, that puts a huge energy burden on people," Lincoln said.

Texas is one of the states that restricts telehealth and mail access for medication abortions. The state also recently passed a law banning abortions after the detection of a fetal heartbeat, which can be as soon as six weeks.

If people travel to a state that allows for telehealth visits for abortion, they may conduct the visit in any area of that state. The FDA decision may still benefit people who have the time and resources to travel to another state as it's easier to conduct a telehealth appointment than scheduling a surgical procedure, Shepherd noted.

"This is another way that someone who has an early pregnancy can get the care that they need, without being turned away, because the surgical option is not available due to timing," she said.

Pro-Choice Advocates: The Fight Is Not Over

The FDA didn’t remove all restrictions on the abortion pill. There are specific qualifications for how, where, and by whom the pill can be prescribed. The agency requires the pill to be dispensed under a program called Risk Evaluation and Mitigation Strategy (REMS), which requires a signed patient agreement form and that the pill can only be prescribed by certified healthcare providers.

“I think it’s frustrating,” Lincoln said, adding that the abortion pill has fewer side effects than some over the counter drugs like Tylenol. “I'm hoping that will change.”

The FDA’s decision to allow abortion pills by mail is a big step in increasing abortion access, but it’s just one step, Shepherd said. There remains work to be done in increasing points of care and in separating health decisions from legal actions, she added.

“Abortion is a form of health care, and it should be prioritized and not demonized,” Shepherd said. “The ways that we can do that are to continue to provide fair access for women, and make sure that we don't make legislation and law a big part of how we provide health care.”