As Growing Number of States Pass More Restrictive Abortion Legislation, Some U.S. Women are Taking Reproductive Matters Into Their Own Hands by Ordering Abortion Pills by Mail

Proponents of a proposed Massachusetts legislative bill, called the “Roe Act” by supporters, wear pink shirts, while opponents of the bill wear red shirts as they listen during a public hearing at the Statehouse in Boston on June 17, 2019. (Photo: Steven Senne, AP)

In Aid Access’ first year of operation, 21,000 U.S. women reached out to the online organization launched in March 2018 that offers abortion pills internationally. Requests came from all over the country ⁠– especially states where abortion is tightly restricted.

After a string of states passed bans or limits in recent weeks, pushing the abortion debate in the USA to a fever pitch, abortion rights advocates said those numbers could climb.

In 2019, more than a dozen states have either passed or tried to pass more restrictive abortion legislation. Alabama, Georgia, Kentucky and others moved to ban abortion when a fetal heartbeat is detected, which is within six weeks of a pregnancy. Georgia’s bill allows exceptions for rape and incest, but Alabama’s does not.

By the numbers: Fewer women are having abortions. Why?

Francine Coeytaux, co-director and co-founder of Plan C, a website geared to helping women understand abortion pills, said views on her site skyrocketed after the Alabama Senate passed its bill in May. Plan C has a report card ranking online abortion pill providers based on shipping time, physician oversight and product quality.

“When the law was passed in May, the Alabama law,the next day we had a 1,600% increase on our report card,” Coeytaux said. “We have reason to believe that sales in the U.S. last year of abortion pills were probably in the hundreds of thousands.”

What are abortion pills?

Medication abortion, also known as abortion with pills, was approved by the Food and Drug Administration for use in the USA in 2000. The two pills used are mifepristone and misoprostol; the first stops the pregnancy’s growth, and the second empties the uterus.

Medication abortion before eight weeks’ gestation accounted for 24.6% of all abortions in the USA in 2015, according to the latest figures from the Centers for Disease Control and Prevention. The FDA said taking the combination of pills in the first trimester has a success rate of 95% to 99%.

Abortion pills are different from birth control pills, which are a form of contraception. They’re also different from Plan B, an emergency contraception that works to prevent pregnancy when taken within 72 hours of having unprotected sex.

Abortion with pills has proved to be a relatively safe, easy option during the early stages of pregnancy, according to the FDA. Still, the agency imposed restrictions by limiting distribution to providers with specific certifications. Certain states require in-person administration of the pills, which hinders access within more rural communities.

“Medication abortion has an extensive safety record, and the evidence suggests that the restrictions placed on it by the FDA are unwarranted,” said Megan Donovan, senior policy manager at the Guttmacher Institute. “Medical organizations have called for lifting the federal restrictions on medication abortion.”

Ingrid Skop, an OB-GYN based in San Antonio and chairman-elect of the American Association of Pro-Life Obstetricians & Gynecologists, expressed concerns about women with ectopic pregnancies obtaining abortion pills from providers not meeting the FDA’s criteria.

“The first pill does nothing to end a tubal pregnancy, and tubal pregnancies rupture the tube,” Skop said. “A woman who orders it online without the provision of a doctor is going to have no idea if she has an ectopic pregnancy.”

Elisa Wells, co-founder and co-director of Plan C, said the reasoning behind restrictions of this method of abortion is political, not medical.

“This is a very safe procedure that could be helping people,” Wells said. “There’s no medical reason for why it can’t be more widely available than it is outside. It’s purely political at this point. People need to know that these pills are so safe.”

What are the downsides?

Click here for more.