Self-Managed Abortions May Be More Difficult to Access Right Now—Here’s What You Need to Know

With supply chain disruptions in India due to the global COVID-19 pandemic, medication abortion may be less accessible—an issue compounded by anti-choice state officials trying to ban the procedure and the FDA.

[Photo: A pill lays on top of a mifepristone blister pack.]
Advocates say that people seeking abortion need to be able to exercise their right to access abortion care, and though the FDA could change the classification of mifepristone, it isn’t. Phil Walter / Getty Images

For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.

If you visit AidAccess.org in search of the abortion pill right now, you won’t be able to find what they’re looking for. Aid Access, a website that offers medication abortion pills by mail for people in the United States seeking to self-manage their abortion, has hit a snag in its supply chain, thanks to a halt in trade out of India because of the coronavirus outbreak.

“Because of [COVID-19] the government of India have decided to close all international airports to prevent corona virus outbreak and therefor [sic] the pharmacy in India cannot send the medicines until further notice,” reads a disclosure on the Aid Access website’s consultation page.

In normal times, healthy people who have been pregnant for less than nine weeks are able to consul with a doctor through the Aid Access website and get the medication abortion pills, misoprostol and mifepristone, delivered to them directly from a pharmacy based in India. It’s a service especially crucial for people unable to access abortion care in their city or state.

“The biggest disruption to what we are doing [at Plan C] … is that with the airports being closed in India, the supply of Aid Access has been cut off,” said Elisa S. Wells, co-founder and co-director of Plan C, an organization that advocates for self-managed abortion care and medication abortion pill access. Aid Access and other online providers have been a reliable resource for patients as some states become increasingly hostile to abortion rights. “Aid Access has been a real safety net and now they aren’t able to provide anything,” Wells said.

Medication abortion, commonly referred to as the abortion pill, is growing in popularity for earlier abortion care. Even though medication abortion is safe and common (as are procedural abortions), the U.S. Food and Drug Administration (FDA) mandates that the first pill taken to induce an abortion, mifepristone, must be prescribed by a health-care provider with specific qualifications and can only be dispensed in clinics, medical offices, and hospitals—not at pharmacies. This is a huge barrier: According to the Guttmacher Institute, 89 percent of counties in the country don’t have an abortion provider.

Why isn’t mifepristone available at pharmacies while misoprostol is? Jill Adams, executive director of If/When/How, a legal organization supporting reproductive justice, called the requirement unnecessary and said it prevents patients from being able to access the care they need.

The fight to ensure access to abortion entails both changing abortion laws and changing public perception of the procedure, Adams said: “A big part of people’s resistance to self-managed abortion stems from their uninterrogated allegiance to the medical model of care, and to believing that we are not capable of knowing our bodies and caring for bodies, and that we must rely on people in white coats to tell us what to do.”

The difficulties of accessing medication abortion are further exacerbated by the COVID-19 outbreak, which has not only caused disruption to the international supply chain, but has been used as an excuse for some state authorities to try and ban the procedure. Patients in Texas are traveling upwards of 800 miles round-trip to see their nearest provider. Missouri is battling to keep its last remaining clinic open.

In some states, advanced practice clinicians, like physician’s assistants and nurse practitioners, can also prescribe mifepristone, but that too requires that a patient navigate the medical system.

Providers who prescribe mifepristone are supplied by Danco Laboratories and GenBioPro, both FDA-approved distributors. Representatives for Danco Laboratories and GenBioPro told Rewire.News that they’re not concerned about running out of stock as a result of the global pandemic.

“We haven’t noticed a direct effect,” Abby Long, director of marketing and public affairs for Danco Laboratories, said. “We have plenty of inventory in the U.S.” For a patient who lives within an hour’s drive to a clinic, this might come as a relief, but for any of the 11 million who live more than an hour’s drive away, the prospect of accessing the medication while under a shelter-in-place order might be daunting or impossible.

Advocates say that people need to be able to exercise their right to access abortion care, and though the FDA could change the classification of mifepristone, it hasn’t. So while COVID-19 disrupts the supply of abortion pills for those who want self-managed care, the FDA further limits legal access by refusing to adjust its regulations.

In March, California Attorney General Xavier Becerra and 20 other states’ attorneys general wrote a letter to the FDA demanding that it lift the Risk Evaluation and Mitigation Strategy (REMS) classification that limits providers’ ability to offer a medication abortion through telemedicine.

“Despite Mifepristone’s benefits and safety, the FDA subjects it to a REMS designation that is outdated, inconsistent with medical evidence, and limits healthcare providers’ ability to use telehealth and provide this necessary drug, ultimately limiting patients’ access to care,” the letter says.

Advocates say that forcing a person to carry a pregnancy to term because they cannot access a provider jeopardizes their health rather than protects it.

“Trying something that’s really unsafe, that’s another worst case scenario,” Wells said, bringing up the possibility that pregnant people may resort to alternative methods to self-manage an abortion. “It’s awful to even have to consider that possibility,”

What the letter doesn’t say, and what the FDA is reticent to acknowledge, is that all medication abortions are partially self-administered to begin with, Adams said. Limiting public access to medication abortion by mandating that a provider oversee a patient as they take mifepristone is born out of political ideology, not medical standard, she said.

In fact, mifepristone is 14 times safer than carrying a pregnancy to term in the United States.

Adams calls the limitations on mifepristone an “abuse of state power” that allows state officials to conduct a kind of passive surveillance on patients in their own homes.

“Anti-abortion officials have been capitalizing on the crisis to promote their dangerous agendas, to control pregnant people, and to limit their access to clinical care,” Adams said.