New regulations and bans on abortion have been increasing rapidly in several states since the overturn of Roe v. Wade in 2022. Due to these limitations, interest in Mifepristone by online order and telemarketing has grown. Mifepristone is a medication used for medical abortion in early pregnancies that has become more recently available through the mail in recent years. While the drug is generally considered safe and effective, new regulations and restrictions are attempting to limit its distribution.
When combined with misoprostol, Mifepristone can terminate a pregnancy in the first ten weeks by blocking the progesterone hormone. It is a drug that “The FDA has determined that it is not necessary for the REMS to mandate how providers clinically assess patients for the duration of pregnancy,” making the drug shipment the easiest option. [7]
Medicated abortion makes up about 54% of abortions in the United States [2]. Therefore, many will turn to online ordering for access if that medication is no longer allowed in a specific state. Currently, in states where abortion, both medicated and procedural, has been deemed illegal, access to the pill by mail is still permitted. Although red tape has increased since the overturn of Roe v. Wade.
To limit access, the Food and Drug Administration (FDA) implemented the Risk Evaluation and Mitigation Strategy (REMS). This program required that Mifepristone be only prescribed and dispensed by healthcare providers who have completed the necessary certification process. While this may limit the pill’s access, it does not account for overseas shipments. The FDA then issued a regulation in 2020 that Mifepristone could not be dispensed by mail for fear of complications that would require medical assistance.
This restriction has been criticized by reproductive rights advocates, who argue that it puts unnecessary burdens on women seeking medical abortion and can result in delays in care. They say that telemedicine is safe and effective for medical abortion and that the FDA’s restrictions are not based on scientific evidence.
Similarly, in Canada, Mifepristone is only available through a prescription from a healthcare provider and cannot be dispensed by mail. The restrictions on Mifepristone by mail have been criticized as a barrier to accessing safe and effective abortion care, particularly for women living in rural or remote areas.
In contrast, some countries, such as the United Kingdom, have allowed Mifepristone by mail under certain conditions. In the UK, Mifepristone can be prescribed by a healthcare provider, dispensed by a licensed pharmacy or clinic, and then sent by mail to the patient. The use of Mifepristone by mail in the UK has been shown to be safe and effective and has been praised for increasing access to abortion care, particularly for women in rural areas. [6]
As for the postal service, at this time, they “cannot be held criminally liable for conducting their duties by delivering mail that contains medication that can induce abortions” [2]. The postal service has held its ground and will continue its existing practice of delivering the pill. It has stated it will make no efforts to prevent mailers from sending such medications. Therefore, the issue boils down to the pill’s prescriber, provider, and receiver rather than the postal service itself.
However, in 2021 this was challenged in court, and the restrictions were ruled unconstitutional by the supreme court. Many challenged this using the Comstock Act as evidence. This concern was due to the Comstock Act of 1873, which prohibited the delivery of “obscene” items or contraceptives. However, because Mifepristone can be used for other purposes and recipients do not have to claim how they will use the item, neither party involved in the delivery of the pill can be persecuted. [5]
As of today, the clarity of the issue remains foggy; many states are directly attempting to block access to abortion pills and attempting to block access to abortion pills [5] and incriminate providers. The Justice Department still states that it is legally allowed to deliver the pill to states where the procedure is outlawed. Therefore, it is still possible for women to get a legal prescription “via telehealth consultation with a health professional, and then receive the pills through the mail” [3].
The extreme complications and complexity of the issue surrounding mail-order abortion is one that changes day by day. The ability to ship something overnight is a fairly never ability, and rapid developments like these are making the issue more difficult to manage each day. When the issue of state’s rights crosses with the FDA, the supreme court, the post office, and overseas shipments controlling a drug only illegal in certain areas can become messy. As many fight for the right to abortion in their state, I think many will begin to fight for the freedom to mail the pill into their state as this will become more prevalent as more and more states crack down on abortion.
-Molly Weinberg
Works Cited
[1] “Gender & Identity.” The Washington Post, WP Company, https://www.washingtonpost.com/gender-identity/.
[2] Katz, Eric. “The Postal Service Can Continue to Deliver Abortion Pills Anywhere in America, DOJ Says.” Government Executive, Government Executive, 4 Jan. 2023, https://www.govexec.com/management/2023/01/usps-can-continue-deliver-abortion-pills-anywhere-america-doj-says/381441/.
[3] Perrone, Matthew. “FDA Finalizes Rule Change Allowing Mail-Order Abortion Pills.” PBS, Public Broadcasting Service, 3 Jan. 2023, https://www.pbs.org/newshour/politics/fda-finalizes-rule-change-allowing-mail-order-abortion-pills.
[4] Spencekimball. “Women in States That Ban Abortion Will Still Be Able to Get Abortion Pills Online from Overseas.” CNBC, CNBC, 27 June 2022, https://www.cnbc.com/2022/06/27/women-in-states-that-ban-abortion-will-still-be-able-to-get-abortion-pills-online-from-overseas.html.
[5] “Justice Dept.: Despite Bans, Abortion Pills May Be Mailed to Any State.” The Washington Post, WP Company, 5 Jan. 2023, https://www.washingtonpost.com/national-security/2023/01/04/abortion-pills-mailed-legal/.
[6] Abortion Safety and Use with Normally Prescribed Mifepristone in Canada …https://www.nejm.org/doi/full/10.1056/NEJMsa2109779.
[7] Center for Drug Evaluation and Research. “Questions and Answers on Mifeprex.” U.S. Food and Drug Administration, FDA, https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation.
[8] Farley, Robert. “Noem’s Misleading Claim about Safety of Medication Abortion.” FactCheck.org, 12 July 2022, https://www.factcheck.org/2022/07/noems-misleading-claim-about-safety-of-medication-abortion/.
Not only does REMS clearly create barriers to access medicine and necessary treatment for lower-income women, women in rural areas, women without transportation, etc., but it also creates a false narrative that certain medicines should be considered “obscene”. If you can buy Viagra or Plan-B online I see absolutely no fair reason why Mifepristone should be treated as an obscene item or contraceptive. Not only is the Comstock Act incredibly outdated, but when used in this case it disregards thousands of other “obscene items” that won’t be banned from being shipped because they don’t fall into hot water with such polarizing debates like abortion-related products and services do.
Also, Mifepristone is not only an abortion medication but can also be used to treat Cushing’s syndrome and uterine leiomyomas. To read more on the drug see here; https://www.ncbi.nlm.nih.gov/books/NBK557612/. Therefore, when you ban this “obscene contraceptive” you’re also banning a life-saving drug for others that may be inaccessible in any other way besides through mail.
Plan B in particular always stood out to me because it is never brought up in these debates, only because it does not induce an abortion but prevents pregnancy — that is, only because mere implantation of a cell has yet to occur. That such a small biological process is the difference between a heavily legislated contraceptive and one that remains easily available is fascinating to me, though I suppose everyone has to drawn their line in the sand somewhere.
I think that the evocation of outdated laws and flawed science is so indicative of the lengths that opponents of abortion will go to in order to prevent the practice. I’m glad, however, that the Postal Service has held its ground and protected providers’ ability to send medicine in the mail. I think this issue of Mifepristone by mail speaks directly to the language used in Roe v. Wade that addresses the right to privacy, especially considering that mail is historically one of the biggest sticking points in the privacy debate. I hope that, going forward, cases like Alliance for Hippocratic Medicine v. FDA can help to further protect Mifepristone from unfair and biased regulation.
The discourse around mifepristone by mail showcases the intersection of political polarization, inability to access proper reproductive healthcare, and controversy in the field of medicine/technology. The continuous push against abortion shown by mifepristone bans exemplifies the ongoing process of trying to make all abortions be seen as an act of malicious intent. You did a great job explaining the complexities of mail-order abortions and how this issue continues to evolve after the overturning of Roe v. Wade. It’s interesting to read how as mailing and shipping become more efficient, it further complicates the use of mifepristone.
This is a very informative post Molly, I like how much raw information you brought to the table and dove deeply into the topic at hand. In relation to the FDA controlling this substance, I think it is very interesting how an administration that is very satellite in reference to our central government, is making decisions on something that is at the very center of many women’s lives. Do you think there is a bit that gets lost in translation when 3rd party and smaller government agencies try to convey the message of central government, or maybe they even don’t care about that?
While reading this, I kept thinking that it is incredible how fast the laws change, especially on the state level. As soon as one barrier was created, another one followed. I remember first hearing about it on the news and one of the people said that in states where Mifepristone is illegal, they had until the end of the week to go out and buy it before it was taken off the market. The speed in which this policy was enforced was honestly shocking. I also found it interesting that even in states where medicated abortion is illegal, a person can still get a prescription sent to their house by mail, use it, and it be completely legal. I am only shocked because I would have imagined that the policy makers who put these laws in place would have also tried to find a way to make that illegal as well.
The first thing I thought while reading this was the Plan B pill, I think the way the Milfpristone is shipped is similar to how a Plan B can be bought so easily. However I do think that is that plan B doesnt terminate pregnancy like the Milepristone. However I feel like every time something new becomes accessible to women, someone creates a scene and excuse to take it down again. there is always criticism to prevent the rights of women.