The New York Times: Abortion Pills Should Be Everywhere

Farhad Manjoo

“… Amid growing restrictions on clinic-based abortions, the online pill market functions as a haven of last resort for desperate women. “The women who come to us don’t have any other alternatives,” said Rebecca Gomperts, a Dutch physician and founder of Aid Access, which offers abortion pills online for about $90, with discounts for patients in financial straits. “They don’t have funds, or they are six hours away from the clinic, or they don’t have transport, they have small kids, they live in cars, there are situations of domestic violence — it’s just really bad situations.” In 2018, Gomperts prescribed the drug online to 2,581 patients.

But the pills aren’t just a way to evade today’s restrictions on abortion. Some activists argue that they can also remake tomorrow’s politics surrounding abortion — that the very presence of the underground market could force the authorities to loosen restrictions on abortion pills, eventually paving the way for an alternative vision for terminating a pregnancy in the United States: the inexpensive, safe, very early, private, at-home, picket-line-free, self-managed medical abortion.

“Did you feel a little rush when your pills arrived?” Elisa Wells, a director of the pill-advocacy group Plan C, asked me during a recent phone call. “It’s like, wow — it’s amazing that this really works.”

She’s right: I did feel a little rush when I got my first pills. I’d expected the whole thing to be onerous. And so, probing for hidden difficulties, I tried again, and again.

In the last year, I’ve ordered abortion pills from four different online pharmacies. The process was sometimes sketchy. There were poorly translated websites and customer-service reps messaging me over Skype with the greeting “yo.” I declined to pursue one order because the site asked me to wire money to a random address in India. After I filled out its consultation form, Aid Access sent me an email asking me if I really am pregnant, as I have a man’s name and “the woman must confirm” that she is ordering the drugs of her own accord; since I’m a man and not pregnant, I didn’t place the order.”

Read the full article here.

Anchorage Press: Plan C: A vital resource for women in Dunleavy's Alaska

Grey Areas by C. Grey LaClair

“… In essence, abortion medications induce the natural functions of our own bodies. Before six weeks, the risk of miscarriage is up to 75%. Between six to twelve weeks – the time when most abortions are performed – the risk is up to 20%. Women have been encouraging their bodies to perform this normal process for thousands of years by means of intense exercise, herbs, massage, surgery, yoga twists, and tight girdles. Similarly, prior to modern birth control, women found their own means of contraception, not only herbs and abstinence but also practices like syncing their cycles and then leaving the village together while ovulating, presumably for great adventures.

Elective abortion in humans has happened throughout history, as a natural course of events and the lack of abortions a and general exploitation of our bodies, akin to the earth, is cumulatively the root of the unusual event of population explosion in the 20th century. This, of course, has been a mixed blessing. Indeed, female animals including mice, monkeys, and horses, have also been found to intentionally abort their fetuses at times. Even the authors of the Bible did not feel that abortion was important enough to explicitly mention, nevertheless prohibit, despite it regulating menstruation, childbirth, libido, and rape. This lack of theological foundation evidences the self-serving, malicious, and discriminatory nature of the religious right’s attack on women that should outrage us all.

At some point, if enough women self-manage their abortions and enough people support those who do, the government will not be able to go after us all. We need to stand tall against Dunleavy and his blows at our physical autonomy by letting other women know they have options. As a final note, please do not take this article as a substitute for advice from your medical or legal professional. Be safe and think for yourself!”

Read the full article here.

VICE: Buying Abortion Pills Online Is Overwhelmingly Safe, But Maybe Illegal

“… I was most surprised and excited that every single pill we ended up receiving had at least some of the medication advertised,” Murtagh told VICE. “On the other hand, I was definitely concerned that some of the pills had less medication than expected, and probably more so, how long some of the packages took to arrive. Neither of those would necessarily threaten one’s health, but using ineffective pills and waiting a while for them is just lost time in a time-sensitive situation.”

Based on the research from Murtagh and her team, the reproductive health organization Plan C created a “report card” that grades online abortion pill retailers based on their pricing, shipping time, product quality, and physician oversight. The organization doesn’t make recommendations or advise people on whether they should manage their own abortions but founder Amy Merrill said she believes buying pills online to end a pregnancy is safe and effective if you know for sure that what you’ve bought is the real thing—and Plan C’s report card can help people verify that. 

“I just keep coming back to the data about the safety of the method overall,” Merrill said. “It’s safer than Viagra to use this method of ending a pregnancy, and that includes people taking these pills from a clinic as well as ordering them online.” 

There’s plenty of science and research backing Merrill up. The combo of mifepristone and misoprostol was first approved as an abortifacient in France and China in the late 1980s, and the World Health Organization has recommended it as a method for ending abortions since 2013. Earlier this month, the WHO updated its official guidance on the drugs, getting rid of the stipulation that once stated that using them required “close medical supervision.” Merrill said the guidance only buoys the mounting evidence that using abortion pills is a safe and effective method of ending a pregnancy.”

Read the full article here.

Narcotica: Episode 24: How To Get Abortion Pills Feat. Lynn Paltrow and Francine Coeytaux

“What does abortion access have to do with the war on drugs? EVERYTHING. On this episode, we talk about some of the most controversial drugs of them all, drugs that are often overlooked in the debate about reforming drug policy: abortifacients, drugs that induce miscarriage, ending pregnancies. Specifically, misoprostol and mifepristone. We speak with Lynn Paltrow, the founder and executive director of National Advocates for Pregnant Women and Francine Coeytaux co-founder of Plan C Pills, co-founder of the Pro-Choice Alliance for Responsible Research, and a founder of the Pacific Institute for Women’s Health.”

Find out more on the episode and Narotica Podcast

USA TODAY: Some US women are taking reproductive matters into their own hands: They're ordering abortion pills by mail

by Elizabeth Lawrence

… "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? 

Traffic on Plan C's website has grown significantly in recent years, Wells said.

It's not just the surge of restrictive abortion bills causing women to pursue other options but a steady legislative effort to limit access, she said.

"The more people are restricted, the more likely that they are going to try to manage an abortion on their own," said Gretchen Ely, an associate professor at the University at Buffalo specializing in access to abortion and contraception. "So instead of it being a pre-Roe situation with objects, they’re going to be looking to manage it with medication. More often, it will be unsupervised." 

Read the full article here. Defiance and Innovation Keep Abortion Available, If Not Legal


… Amidst the always heated debate over abortion, Aid Access isn't the only organization assisting women who want access to abortion pills from overseas suppliers. With Alabama and Georgia only the most prominent among the states approving draconian new restrictions on terminating pregnancies, plenty of outfits see both need and profit potential in the large numbers of women who lack easy, legal access to abortions. The same day that Aid Access received the letter in which "FDA requests that you immediately cease causing the introduction of these violative drugs into U.S. commerce," India-based pharmaceutical company Rablon received similar official hate mail.

In fact, there's enough competition in the abortion pills-over-the-Internet market that Plan C, a website sponsored by the National Women's Health Network, maintains an online report card comparing price, quality, and shipping speed. (Aid Access gets the only "A" grade, by the way.)

The drugs supplied by Aid Access, Rablon, and the other players in this gray market sector are mifepristone and misoprostol. Both are recognized by the American College of Obstetricians and Gynecologists (ACOG) as "safe and effective" means of ending pregnancies, especially when used together.

While legal in the United States, the drugs are subject to an FDA Risk Evaluation and Mitigation Strategy—tight restrictions on who can dispense them and where they can be used. Under the restrictions, mifepristone "may only be dispensed in clinics, medical offices, and hospitals by or under the supervision of a certified healthcare provider," among other limits on its availability.

Of course, as with so many restrictions on controversial goods and services, it's very likely the rules were put in place not to protect patients from especially dangerous medications but as barriers to access in lieu of an overt ban. That's what ACOG thinks, anyway.

"ACOG opposes regulations or restrictions that are inappropriately unique to the provision of abortion," the professional organization said last year. "ACOG recommends that mifepristone for reproductive health indications be made available in retail pharmacies like other prescription drugs and without unique provider certification or patient consent requirements."

But the barriers remain in place, and online suppliers based overseas continue to bypass those legal restrictions to reach customers who want what they have to offer.

"As it is generally accepted that the FDA has no authority over the practice of medicine by licensed doctors in the U.S., it is surprising that the FDA would now be claiming to have authority over the practice of medicine by a licensed doctor in Austria," Aid Access's attorney, Richard A. Hearn, wrote to the FDA in a May 16 response. "When U.S. women seeking to terminate their pregnancies consult Dr Gomperts, she will not turn them away."

Aid Access continues to consult with American patients via telemedicine from overseas and issue prescriptions to be filled by pharmacies on the other side of the planet, no matter what U.S. officials may think of the situation.

Read the full article here.

East Idaho News: Pocatello attorney defending European doctor who is defying FDA orders to stop sending abortion pills to US women

by Jessica Ravitz, CNN

Why Aid Access

Gomperts suggested in an email that the federal restrictions amount to hypocrisy.

“In direct opposition to its mission — to protect the public health by ensuring the safety, efficacy, and security of drugs — the FDA has so severely restricted access to these safe and effective pills that few doctors are willing or able to prescribe mifepristone and misoprostol,” she wrote.

So through Aid Access, she began prescribing abortion medication to women in the United States last year. It was an outgrowth of her 13-year-old program Women on Web, which offers this kind of service to women in countries where abortion is illegal. The nearly 1,000 emails she’d received from people in the United States seeking help, some so desperate that they threatened to harm themselves, she said, prompted her to broaden her outreach.

“I realized it was time,” she said last fall. “Something had to be done.”

She has consulted “with women in all 50 states and the District of Columbia,” attorney Hearn said in his letter to the FDA. “Of the 11,108 women who consulted with Dr. Gomberts in 2018, 2,581 were prescribed medicine approved by the FDA to induce a medical abortion during the early stages of their pregnancies.”

Of those she’s served, Hearn said, Gomperts is “not aware of a single death, hospitalization or serious complication attributed to the prescriptions she prescribed for her patients in the U.S.”

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, according to the grassroots group Plan C, which aims to educate women about self-managed abortion. Aid Access also offers the possibility of financial help, according to its website.

Plus, it’s the single source to offer physician oversight, according to a Plan C report card.

Aid Access is the only one of eight suppliers to receive a grade of A.

What happens next

A 2015 study showed abortions by medication to be about 97% effective. Interest in self-managing or self-inducing abortions is on the rise, according to reports.

In a one-month period in 2017, research published last year showed, there were nearly 210,000 US Google searches for information about self-abortion. This indicates a demand for alternatives, perhaps driven by barriers to clinic access due to financial hardship, geographic distance, fear of being publicly shamed or other reasons.

Read the full article here.

Medium: Trendy Health Startups Still Don’t Offer What Women Need

by Lux Alptraum

… “We need innovation in abortion care,” says Elisa Wells, co-founder and co-director of Plan C, an advocacy organization that provides information about access to medication abortion. Even in states like New York, where there are few legal restrictions to providing abortion care, people seeking out the service are limited to a handful of clinics mostly based in major cities. Wait times can be long and appointments limited and at inconvenient times. Even something as simple as increasing the number of abortion providers could have a dramatic impact on women’s access and experience — and yet fewer than 2,000 doctors in the U.S. provide abortion services.

If so many reproductive health care startups recognize and understand that abortion is an essential component of women’s health, why are so few stepping up to disrupt abortion access and make the service effortless to obtain?

Abortion providers in the U.S. face a number of challenges, including the punitive legal restrictions, which are on the rise across the country. While the laws passed by Georgia and Alabama are often difficult to enforce (if not outright unconstitutional), onlookers say the restrictions have a chilling effect on doctors and clinics that might otherwise offer abortion services.

Providers also face a business model that requires them to provide a high-cost service to an often low-income client base. On top of that, providing abortion is still stigmatized work — work that can put a physician in the crosshairs of potentially violent anti-abortion zealots. “Why does anyone do this work?” says Melissa Grant, co-founder and COO of the abortion provider Carafem, with a laugh.

Carafem is an anomaly. It’s a new health care company that’s investing in and streamlining reproductive health care using modern technology. Abortion is their primary service.

Grant came to Carafem after years of working with family-planning organizations across the U.S. As she worked to connect people to abortion providers, she became frustrated with the barriers to access, and she wanted to figure out a way to make it easier to get an abortion. Her co-founder, Christopher Purdy, came from a more international background — as CEO of DKT International, he spent his career improving contraceptive marketing and messaging in the developing world — and the job left him befuddled about the state of abortion access in one of the richest countries in the world. “He pondered out loud why it was possible that in some areas of the U.S. it was more challenging to get an abortion than to get one in Ethiopia,” Grant says. (While Ethiopian law places some restrictions on who can have an abortion, the service is available at the majority of venues that are capable for providing abortion, including 98% of the country’s public hospitals.)

Read the full article here.