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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.
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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/.