As Abortion Access Shrinks, People Turn to Imported Pills

Women will increasingly look to manage their own abortions as clinics close and laws become more restrictive, doctors and advocacy groups say.

Thanks to the internet, women don’t even have to leave their homes if they’re looking to terminate a pregnancy. A growing online community offers health care providers who connect people with overseas pharmacies that send them a combination of pills—mifepristone and misoprostol—used to end early-stage pregnancies.

The debate over abortion access has yet again taken center stage in the U.S. as states pass laws making it more difficult to terminate a pregnancy; the Trump administration implements new regulations propping up religious rights; and Democratic presidential candidates incorporate abortion access into their campaign platforms.

The first pill in the treatment, mifepristone, blocks a woman’s progesterone and stops a pregnancy from advancing. The second pill, misoprostol, causes cramping and bleeding that empties a woman’s uterus. Mifepristone is only available directly from a health care provider but misoprostol is available at pharmacies with a prescription.

Globalization is making these medicines more widely available. For example, a physician based in Austria is using telemedicine to connect people with a pharmacy overseas that will send them the mifepristone/misoprostol combination.

“If someone cannot or should not be pregnant they will end that pregnancy,” Dr. Jamila Perritt, an obstetrician and gynecologist who specializes in family planning, said.

Daniel Grossman agrees. He’s director of Advancing New Standards in Reproductive Health at the University of California, San Francisco, and studies family planning access. “I definitely think that as the barriers to accessing clinic-based care become more extreme that more people will try to end a pregnancy on their own without medical assistance,” he said.

And that creates a regulatory quagmire for the Food and Drug Administration, which is already trying to crack down on imported drugs.

Abortion Pill Imports

The agency has already tried to shut down the Austrian doctor’s operation, which is run through a website called Aidaccess. It sent a warning letter in March to its leader, Dr. Rebecca Gomperts. As is standard in warning letters, the FDA said if the company didn’t stop sending pills the agency could take “regulatory action including seizure or injunction, without further notice.” Gomperts’ lawyer responded in a letter earlier this month saying the FDA was “violating the constitutional rights of Dr. Gomperts’ patients in the U.S.”

In a post on her website Gomperts remains defiant: “I will not be deterred,” she wrote. “When U.S. women seeking to terminate their pregnancies prior to 9 weeks consult me, I will not turn them away. I will continue to protect the human and constitutional right of my patients to access safe abortion services.”

The FDA wouldn’t comment on how it has responded to that letter or more specifically on its potential future action. “We remain very concerned about the sale of unapproved mifepristone for medical termination of early pregnancy on the Internet, because this bypasses important safeguards designed to protect women’s health,” a spokesperson said.

Drugs that circumvent “regulatory safeguards” aren’t safe and may be “contaminated, counterfeit, contain varying amounts of active ingredients, or contain different ingredients altogether,” the spokesperson said.

The agency’s concern about fake drugs is understandable, Mary Alice Carter, a senior adviser at the pro-abortion group Equity Forward said. “But I do believe we need to take a hard look at why, when we live in a country where abortion is still legal, women feel more comfortable ordering something online and having it shipped to them” rather than going into a facility in their community, if there is one, she said.

Criminalization in Question

Pro-abortion groups also expect criminalization of abortion to increase—especially for people with low incomes and minority communities—as self-managed abortions get more popular and laws get more restrictive.

“We will absolutely see more communities being targeted for criminalization and prosecutions,” Perritt said.

There are at least 21 arrests since 2000 of people who have allegedly self-managed their abortion or for a doctor performing an abortion, according to Jill E. Adams, executive director for the legal group, If, When, How: Lawyering for Reproductive Justice.

Six states currently have laws directly prohibiting self-managed abortions: Arizona, Delaware, Idaho, Nevada, Oklahoma, and South Carolina, Adams said. And 38 states have some sort of fetal homicide law on the books, according to both the anti-abortion group, National Right to Life and the National Conference of State Legislatures.

Legal experts are still fighting over the recent Georgia “heartbeat” law the governor signed earlier this month, and its effect on abortion prosecution. The law doesn’t include language that penalizes a person for having an abortion, but it lacks any language that protects the person who had the abortion, Adams said.

That sort of legal ambiguity opens the door for authority figures to “go after” people who have terminated their pregnancies, she said. Many district attorneys in Georgia have told various news outlets they wouldn’t prosecute a person who’d had an abortion under the new law.