Ageist: Francine Coeytaux francine coeytaux, 64, public health specialist, los angeles

by Andreas Tzortzis

… Coeytaux’s journey to social scientist and advocate began in rural California, where her French father moved the family after the independence movement in Tunisia forced a change.

“If you ask me where I was born, I was born in Switzerland. If you ask me where I grew, I would say Tunisia. If you ask me what I am, it’s French,” she says. “If you ask me where I’ve lived most of my life? It’s California.”

While studying at Stanford, she spent a semester working at a pediatric clinic in the slums outside Lima, Peru. The stream of women who came with multiple children and questions as to how to avoid future pregnancies made Coeytaux realize that the greater issue — that of family planning — wasn’t being properly addressed in third world countries.

When she moved to New York with her husband in the 1980s and joined the Population Council, that realization became the foundation of her work. Starting with work in Tunisia, she criss-crossed Africa conducting research and helping put family planning programs in place.

Read the full article here.

OneZero - Medium: Telemedicine Will Change How Underground Abortions Work

by Lux Alptraum

…In order to make use of TelAbortion’s services, one has to be able to conduct an online consultation and receive mail within the borders of one of its approved states — simpler and less stressful traveling to an abortion clinic in another state, especially when pills alone are often significantly cheaper than a surgical abortion.

Additionally, online abortion services offer scheduling flexibility rarely afforded by clinics, where abortions may only be available one day a week when providers happen to be on site. “The nice thing about the TelAbortion project is that women are able to obtain the service at a time that’s convenient to them,” says Inga Platais, a program associate for Gynuity.

Easy access to self-managed abortion in some states is hardly a panacea for regressive abortion laws in others.

But even as telemedicine has the potential to radically change our understanding of abortion access, the promise of projects like TelAbortion is currently stymied by FDA regulations. Since its debut on the U.S. market in 2000, mifepristone has been governed by an additional set of restrictions known as Risk Evaluation and Management Strategies (often referred to as the REMS), which severely curtail when, how, and under what circumstances the drug can be dispensed.

Most notably, the REMS requires mifepristone to be dispensed at a clinic, hospital, or medical office — a restriction that makes distribution by mail potentially in violation of FDA policy. As a research project, TelAbortion is given some leeway with regards to the REMS, but until the REMS is overturned, it’s unlikely that we’ll see other U.S.-based telemedicine abortion projects following in its footsteps. Even if it is, it’s possible that states may decide to curtail the expansion of telemedicine abortion, through restrictions that discourage pregnant people from self-managing their procedures at home.

And while the combination of telemedicine and self-managed abortion has the potential to provide an appealing alternative to unsafe back-alley abortions or lengthy trips to the lone abortion clinic in a neighboring state, it’s still far from a perfect solution for people living in anti-abortion states. Easy access to self-managed abortion in some states is hardly a panacea for regressive abortion laws in others.

Read the full article here. Online supplier of abortion pills defies FDA order to stop providing them in U.S.

by Marie McCullough

..Aid Access resumed service the next day.

The FDA declined to discuss its next step. “We cannot comment on a potential future action at this time,” the agency emailed, “but 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.”

The abortion-pill regimen, which is effective through the first nine weeks of pregnancy, actually involves two drugs. Mifepristone, sold in the U.S. by Danco Laboratories and branded Mifeprex, disrupts the pregnancy, then misoprostol triggers uterine contractions and expulsion of the grape-size fetus.

The FDA requires women who want the regimen to make two visits to the doctor, and they can’t get mifepristone from pharmacies. It can only be dispensed in clinics or medical offices by specially certified health-care providers.

Aid Access, in contrast, provides pills after a woman consults online with the prescribing doctor and gets a blood test. She receives instructions for taking the drugs, what to expect, and when to see a doctor if a problem occurs.

Numerous other international websites ship abortion pills — without prescription or any medical oversight. That’s why a group of researchers who support abortion rights created Plan C, a website with a “report card” that rates such websites on product quality, price, and shipping time.

"The combination of very safe and effective medication abortion, and the pervasiveness of global commerce, make Internet access virtually unstoppable,” said public health researcher Elisa Wells, codirector of Plan C.

Read the full article here.

The Cut: Is This the Biggest Threat to the Anti-Abortion Movement?

Rebecca had expected anti-abortion backlash when she started working in America. But getting a letter from the FDA was weird. The FDA doesn’t regulate doctors — and they definitely don’t regulate doctors in Austria, where Rebecca is now based.

Rebecca: I’m a doctor. I work under my jurisdiction. I’m allowed to write these prescriptions and the women can fill these prescriptions by a pharmacy where that can be done. And actually it’s my duty as a doctor when people in need of care and medical care reach out to me. I have the duty to help them if I can. And that’s what I’m doing. That’s that’s what I will continue to do and that’s what I’m doing.

Rebecca has continued her work. When we asked the FDA whether they were going to do anything about it, they told us they couldn’t comment on potential future actions, but that they remained concerned that Aid Access was bypassing, quote, “important safeguards designed to protect women’s health.”

A little while after the FDA sent their letter to Rebecca, 118 members of Congress sent a thank-you note to the FDA commissioner. All but one of them were Republicans. And only ten of them were women … or, fewer than the total number of Jims, Mikes, and Steves.

Read the full article here.

New Statesman: Why so many American women are ordering abortion pills online

by Sophie McBain

…Meanwhile, another American non-profit, Plan C, which was founded in 2015 by two public healthcare experts, Elisa Wells and Francis Coeytaux, is also trying to plug the gaps in American abortion provision by providing women the information they need to obtain an abortion with pills.

It directs women who live in Georgia, Washington State, Maine, Oregon, New York, New Mexico, Hawaii and Colorado to a pilot “TelAbortion” project, which will mail abortion pills to a woman’s home following an online medical consultation.

For others, it offers information on how to safely self-administer a medical abortion. Knowing that many women have already tried to order abortion pills online, without knowing whether they are being scammed, Plan C compiles and regularly updates a “report card” that rates different websites from which you can buy abortion pills.

Wells told me that traffic to Plan C’s website keeps increasing, too. They now average around 40,000 hits a month.

“If the worst-case scenario happens [and Roe v Wade is overturned], there will be more need than ever for groups like Plan C, that are providing information for people to make their own decisions about the medical care they need, and to gain access to that medical care,” says Wells. “There’s no stopping people from accessing information and medications, we have a global economy and a global information system.”

Read the full article here.

Daily Beast: Laws in Georgia, Alabama Spark Interest in Mail-Order Abortions

Sites that offer information on self-administering abortion pills have seen spikes in inquiries.

Plan C and SASS—two sites that provide information on purchasing and self-administering abortion pills—told The Daily Beast they saw an increase in site traffic over the last week, after Alabama passed a law banning almost all abortions in the state. The law has yet to take effect but its passage made national headlines, leading some people to fear abortion was already illegal in their state.

Amy Merrill, the founder of Plan C, said her site saw an eight-fold increase in traffic the day the ban passed the Senate. Susan Yanow, a spokesperson for SASS (Self-managed Abortion; Safe and Supported) said their website saw a nearly 35 percent spike in traffic over the last week.

Read the full article here.

WIRED: Abortion Bans Create a Public Health Nightmare

by Adam Rogers

As any recreational drug user on the Dark Web (or man too embarrassed to ask a doctor for boner pills) knows, online sellers offer the same medications otherwise only available by prescription. That can seem like a scary prospect—are they reliable, are the pills real, will they just steal the money? But when one team of researchers tried to get abortion medications online, they found it actually worked. The misoprostol was often lower-concentration than FDA-approved pills in the US, and some of the packages were damaged, but what they got from 16 different online pharmacies tested as chemically the same, and was usually cheaper than going to a clinic.

Online pills might make this next chapter of abortion history better than the last. “That’s not a crazy idea. It’s not necessarily an unsafe thing to do,” says Elizabeth Raymond, an ob-gyn and researcher at Gynuity Health Products who led the online-buying study. “Part of what’s problematic about the situation is, it’s not clearly legal … If a woman orders these pills from overseas, it’s not clear what the legality of that is.” Raymond’s also doing a study now to see how telemedicine and prescriptions for those drugs could help supplant the dwindling number of clinics in the US.

Read the full story here.

OP-ED: Telemedicine pioneer is under attack by the FDA.  

What you need to know:

On March 8th - International Women's Day - the FDA sent a letter warning online abortion pill provider to cease distributing mifepristone and misoprostol, the two drugs that make up the most effective medication abortion regimen. Aid Access launched last year from the Netherlands to serve pregnant people without access to clinic-based abortion care or prefer to self-manage their abortions at home.

Since its approval in 2000, the FDA has subjected mifepristone to politically motivated, medically unnecessary restrictions guaranteed to limit access. Despite a better safety track record than some over-the-counter drugs, the FDA prevents the sale of mifepristone at pharmacies, making it inaccessible and too expensive for many Americans who can’t afford to travel to a registered clinic to get the abortion pill.

The crackdown is further evidence that the FDA's priority is to make medication abortion harder to access, not to support women. Aid Access provides a vital service to those wanting to safely and effectively self-manage their abortions. If the FDA is truly worried about the safety of imported abortion pills, it's time to lift the restrictions on mifepristone and allow this safe and effective #21stCenturyAbortion technology to be distributed through pharmacies, like most other medications. 

We believe medication abortion is one option of many that people ought to be able to choose for themselves. Reproductive health care needs are as unique as the people who have them, and we must trust that people will make the best decisions for themselves and their families.

Read articles about the FDA's letter here: Online abortion pill provider ordered to cease delivery by FDA,3/15/2019 The FDA orders Aid Access to stop providing abortion pills by mail in the US, 3/16/2019


CNN: Online abortion pill provider ordered to cease delivery by FDA

A European organization that provides doctor-prescribed abortion pills by mail is under order by the US Food and Drug Administration to stop deliveries.

The federal agency sent a warning letter to Aid Access this month requesting that it "immediately cease causing the introduction of these violative drugs into U.S. Commerce."

There are other ways to get abortion pills by mail in the United States, for women who can't get to or afford clinic visits, but Aid Access is the most affordable option at $95. It also offers the possibility of financial help, according to its website. Plus, Aid Access is the only company to offer physician oversight, according to a report card issued by the grassroots group Plan C, which aims to educate women about self-managed abortion. Aid Access was the only one of nine suppliers to receive an A.

Aid Access has 15 business days from receipt of the FDA warning letter, which was dated March 8, to respond. The organization is asked to describe what it will do to remedy any violations, explain why it needs more time to make corrections or offer reasoning for why it is not in violationof regulatory safeguards.

Read the full article here.

Medium: Hers and the Telemedicine Industry Need to Embrace Mail-Order Abortion Pills

Why do telemedicine laws ban abortion pills while offering up dubious libido enhancers?

Elisa Wells, co-founder and co-director of the abortion pill education site Plan C, offers a similar response when I ask her why mifepristone still faces such heavy restrictions, while other, potentially more dangerous medications are freely available online. “It’s because abortion is politicized in this country and highly stigmatized,” she says.

But chalking up this disparity to politics glosses over the specific details of why some drugs are deemed generally acceptable for mass distribution while others are heavily restricted. Medications that aim to increase women’s libidos and supply men with on-demand erections are deemed acceptable, perhaps because they help connect both men and women to sexual pleasure. Yet a medication that helps women deal with the aftermath of that sex — one that grants women complete bodily autonomy and total say over their reproductive destinies — is considered to be far too dangerous to make freely available.

Read the full article here.

Photo: Photo: Towfiqu Photography/Getty, via Medium piece