By Aziza Ahmed and Timothy RB Johnson
Our Bodies Ourselves is a long-time supporter of greater access to medication abortion via the mail and outside the formal medical system. This includes greater use of “self-managed abortion with pills” (defined as accessing abortion outside of the mainstream medical system). It is exciting that we now have an effective technology for early abortion in the form of pills, and that activist networks are organizing across the country to enable more women to obtain these pills, even if they live in states like Texas, with restrictions against their use.
Abortion pills are usually a combination of mifepristone and misoprostol. (Misoprostol is sometimes used alone, although it is somewhat less effective.) Decades of research show that these medications are both safe and effective, with results/outcomes quite similar to clinic-based surgical and medication abortion. As clinic-based options dwindle in parts of the country, access to medication abortion becomes even more critical. That abortions of both types (surgical and medication) have become harder to obtain in many states in the U.S. is the result of politics, overregulation, and over-medicalization –not legitimate concerns about safety.
During 2022, all of us can do more to help people in every state become aware of options that make abortion pills available to everyone who wants them, especially through telehealth services that will deliver pills through the mail. Please share these important messages widely, even in public bathrooms:
- Abortion pills are over 95% effective when used within 10 weeks of the first day of your last menstrual period.
- Abortion pills can be purchased online by anyone in the U.S., either through clinician-supported telehealth services or online pharmacies that mail pills to all 50 states. Individuals receiving these pills can self-manage their care safely.
- Tens of thousands of people in the U.S. are now obtaining pills this way, including many who live in states now trying to stop access.
- It is medically safe to self-manage care using the pills, but obtaining pills through alternative routes may place people at legal risk.
Currently, telehealth abortion services are available in 24 states and Washington, DC, making abortion pills both more accessible and more affordable. Similar services are also available to people who live in states that restrict access to abortions, though few are aware of this option and these alternative routes of access may place people at legal risk.
Plan C is an excellent starting point for up-to-date information on how to access abortion pills. Founded by longtime advocates, the website, available in both Spanish and English, offers referrals to resources that help with legal questions, safety concerns, cost, and other matters. Click here to find a state-by-state directory that provides all necessary details on how to access abortion pills by mail.
Aid Access is another organization that offers online medical consultation and support. After an online consultation, Aid Access has pills mailed to a person’s home, making it possible to obtain pills through the mail in all 50 states, though in some states there may be legal risk involved. (Since 2000 there have been 24 known prosecutions of people who have self-managed their abortions, and most charges were eventually dropped. Every attempt to criminalize the use of abortion pills should be fought vigorously and people who need more specific information to understand their potential legal risk can contact the Repro Legal Helpline, a free service.)
Through Aid Access, people who live in certain states (Alaska, California, Colorado, Connecticut, Idaho, Illinois, Maine, Maryland, Massachusetts, Minnesota, New York, New Jersey, New Mexico, Nevada, Oregon, Rhode Island, Vermont, Virginia and Washington) can have their prescriptions provided by U.S. doctors and receive the medications by mail within a few days. Those who live in other U.S. states with restrictions on abortion medications and people in other countries will need their prescriptions filled from a pharmacy in India, and it can take up to 3-4 weeks after shipment to receive the pills. The cost of Aid Access’s services ranges between $110 and $150 and they have a sliding scale that goes to zero if someone can’t pay. They can also provide pills in advance (to use later if needed).
Some online pharmacies also offer abortion pills with no prescription, charging $250-400+, with no discounts and no medical consultation or clinician support, but they can often deliver in less than a week. Again, there is a possible legal risk to using pills obtained in this way.
Most people who have used online consultations and services have deeply valued the convenience, confidentiality, lower cost and control that they offer. And for those who have no access to personal devices and computers, libraries (and friends) can sometimes provide these necessary resources.
Many primary care providers now acknowledge the importance of making medication abortion more available: “Global Doctors for Choice asserts a vision of medicine that holds patient autonomy and rights at its core, woven together with technical expertise to protect health. Further, physicians and other healthcare providers are well-positioned to advocate for systems that support patient-centered abortion care, providing information and services people need in a way that honors autonomy, dignity, privacy, and physical and emotional safety.”
Because so much research now documents the safety of self-managed abortion, the World Health Organization supports self-use of abortion pills in places where they are not readily available with clinician support. Many U.S.-based healthcare providers now support greater use of this approach as well, especially in states with severe restrictions on access. This blog post from four years ago offers some background on and discussion about self-managed abortion.
Abortion pills are already available over the counter in many countries (as they should be here), where millions of people safely access and use these pills each year without any additional medical support. Some people will want to be prepared and get these pills in advance, much as they would with emergency contraception.
Forcing people to travel long distances, take off time from work, pay for transportation and accommodations, pay for childcare, and sometimes risk exposure to COVID, in order to get an abortion, is completely unjust. And this is the reality for most people in Texas now, when they are unaware of their options for accessing medication abortion despite the restrictive laws recently passed in that state. Self-managed abortion, using alternative markets, is accessible right now for those in Texas.
Already, tens of thousands of people (if not more) are using these alternate routes of access to medication abortion, but many more who could benefit from these services have no idea that they exist. As we strive to change the outrageous laws and other restrictions that now confront more than half of this country, we must at the same time spread the word about the few means that are available to everyone, regardless of income or location.
At the present moment, with so many state-level legal attacks on women’s access to abortion (as well as impending Supreme Court decisions that will likely be decided in a way harmful to access), we need to expand the group of people committed to circulating accurate information about how to get medication abortion, especially via the mail. Please help this information to go viral by sharing this blog.
For more information, see Abortion Pill FAQs: Get the Facts About Medication Abortion.
Aziza Ahmed is a member of the Our Bodies Ourselves Board of Directors. Timothy RB Johnson is a member of the Our Bodies Ourselves Advisory Board and Professor of Obstetrics & Gynecology and Women’s & Gender Studies at the University of Michigan.