All I Want for Christmas Is to Free the Abortion Pill

The FDA is almost done reviewing regulations that have unnecessarily restricted access to medication abortion for more than 20 years.

All I Want for Christmas Is to Free the Abortion Pill
Illustration:Vicky Leta

This year has been truly terrible, especially for supporters of reproductive rights. Abortions after six weeks have been banned in Texas for more than three months and, this week, the Supreme Court’s conservative majority hinted that it might not just uphold a 15-week abortion ban out of Mississippi—it may actually flat-out overturn Roe v. Wade next June.

One possible bright spot is the fact that, after more than 20 years, the Food and Drug Administration may finally treat abortion pills as the safe and effective medications they are and let people get them from the mail-order pharmacy. So while you may be considering buying me a nice scented candle for Christmas, I’ll tell you what I really want this year: Just free the fucking abortion pill. We’ve had enough of this shit.

The FDA approved the drug mifepristone in September 2000 and, when taken early in pregnancy with another drug, misoprostol, the combination essentially induces a miscarriage. (People also use the pills to treat incomplete miscarriages.) But mifepristone has a slew of regulations on it meaning people often can’t get it from their OB/GYN or family doc and pharmacies don’t carry it—they need to see a provider who is registered with the FDA to prescribe mifepristone and will dispense two drugs in person. This often means going to see a provider at an abortion clinic, which have their own intense restrictions like mandatory waiting periods, and may be hundreds of miles away. All this for pills they will take at home and that are safer than Tylenol and Viagra—medications that do not have similar restrictions!

Lawsuits made medication abortion more available during the pandemic—in the 31 states that don’t ban telemedicine abortion, that is—until the Supreme Court halted remote prescribing and pill-mailing in January, days before President Biden took office. Studies show that, wouldn’t you know it, providing safe medications to people via telemedicine and the mail is still safe. In April, the Biden administration reinstated the practice for the remainder of the pandemic, and the FDA said it would review the regulations underlying all the legal battles. The FDA set a deadline of December 16 for this decision. That is, somehow, less than two weeks from now.

It’s not clear what the FDA will do, but they have several options: change nothing, which seems unlikely; allow full telemedicine with mail delivery; or allow telemedicine prescribing with in-person pharmacy pickup. The latter two could mean more providers, like primary care doctors, would get on board to prescribe mifepristone since they wouldn’t have to deal with any dispensing.

Of course, changes won’t happen without backlash. Per Politico:

Another battlefront is emerging over abortion pills. Students for Life, along with several other groups, are working with Republicans in Congress — primarily Reps. Bob Good (R-Va.) and Chip Roy (R-Texas) — to ban online sales of abortion pills and distribution on college campuses.
Eight red states have already enacted restrictions on the pills in anticipation of the Biden administration easing federal restrictions on the drug and allowing it to be prescribed via telemedicine and mailed to homes — a decision the FDA will make later this month. And 16 other Republican-controlled states have introduced bills to limit access.

Aid Access, a humanitarian site run by a Dutch doctor, is letting people in all 50 states order abortion pills before they’re pregnant for $110 to $150. The service may help some people evade state restrictions but does carry legal risks and, for people in more permissive states, it’s not covered by insurance like US-based telemedicine might be.

If the FDA does make changes, they will not apply to everyone equally and pharmacists already refuse people’s prescriptions for miscarriage care and birth control. Better access to abortion pills in blue states is notably not the solution to dozens of red states passing abortion bans. But it would be an important incremental step forward in the project of making abortion more available and integrated alongside other normal and common parts of medical care. So please, FDA, won’t you (start to) free the abortion pill this Christmas?

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