What to Know About Getting Abortion Pills In the Mail

Americans can access abortion pills by mail, but states could limit access now that Roe v. Wade is overturned.

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After the Supreme Court overturned Roe v. Wade, the historic 1973 decision that made abortion legal nationwide, many began to wonder what that could mean for access to abortion pills, which are currently used for more than half of U.S. abortions. While the future of abortion access remains unclear, here's what you need to know about having access to abortion pills by mail right now.

In December 2021, the Food and Drug Administration (FDA) announced that it would permanently allow Americans to access abortion pills by mail. Since the ruling, patients have been able to receive FDA-approved abortion medication, which was initially only available through in-person pick-up, by mail. However, some states have laws in place that prevent their residents from receiving abortion pills by mail, regardless of the FDA's decision.

Nineteen states currently have prohibitions that ban the use of telemedicine for abortion medication, according to The New York Times. And residents of states that have already banned abortions following the fall of Roe v. Wade or have soon-to-be-active "trigger laws" (laws designed to go into effect when Roe v. Wade was overturned) that will restrict all or nearly all abortions will not be able to access medication abortions, either in person or through the mail, reported NBC News in June 2022.

However, the Justice Department released a legal opinion on December 23, 2022 stating that U.S. Postal Service may deliver abortion drugs to all states, as it is not prohibited by a piece of legislation called the Comstock Act. Under the act, it's legal to mail abortion pills if the sender doesn't know the drugs will be used illegally, and there are many ways to lawfully use abortion pills in all states, according to the legal opinion.

The recent decision applies to other mail carriers, such as FedEx and the United Parcel Service, too. Though, it's important to note that it merely addresses the legality of sending abortion pills by mail to states with abortion laws under the Comstock Act. It doesn't address whether or not mailing abortion medication to all states is legal under other federal laws, so it can't guarantee legal immunity.

For many people, the FDA's ruling to allow Americans to access abortion pills by mail still means easier access to Mifeprex (mifepristone), a pill used in tandem with another medication called misoprostol, to terminate an early pregnancy through 70 days or 10 weeks of gestation (i.e. when it's been 70 days or less since the first day of the last menstrual period). The two-part process is safe and effective when prescribed by a qualified healthcare provider, according to the FDA. A study published in Obstetrics & Gynecology comparing the safety of medication abortion through telemedicine and in-person abortion found that the rate of complication was the same (under one percent). To put it into perspective, the FDA notes that of the roughly 4 million patients who have used these medications to induce abortion since 2000, there have been 26 associated deaths as of June 2021.

While the FDA approved Mifeprex in 2016, patients were required to pick up the medication in person until July 2020, when the FDA lifted the requirement due to the pandemic. In the December 2021 update, the FDA announced that the change would remain in place, even after the pandemic is over. The pills still require a prescription, but the FDA allows for mifepristone and misoprostol to be prescribed via a telehealth visit before being delivered by mail.

Though this ruling has helped expand access to abortions for plenty of Americans, abortion laws in the U.S. are currently in question. The fall of Roe v. Wade leaves it up to states to decide the legality of abortion, so the types of abortion available, when they can occur, and in which circumstances varies drastically depending on where you live. And some states have already taken steps to outlaw it: As of January 2023, most abortions are banned in at least 13 states, and it's likely to be prohibited or restricted in others as legal battles continue, according to The New York Times. TL;DR: The legality of accessing abortion pills in states where abortion has been banned or could soon be is currently murky.

It's also worth noting that abortion pills can only be used up to 10 weeks into a pregnancy, which is still too early for plenty of people, particularly those with irregular periods or those who experience birth control failure, to realize they're pregnant, according to current FDA guidance.

However, one abortion pill startup, Choix, will offer abortion pills to patients prior to becoming pregnant for "peace of mind," reports People. This could help people utilize the medication as quickly as possible if they do get pregnant. Though, the telemedicine clinic is only licensed to operate where abortion is legal, including California, Colorado, Illinois, Maine, and New Mexico. So, if you don't live in those states, you won't be able to use the service.

Wisp, a sexual and reproductive telehealth brand, is also working to expand access to abortion pills. It now offers the FDA-approved abortion pill available to order online for $200. People can utilize the service if they actively need the pills. The service includes a consultation with a doctor, and if deemed safe and appropriate, Wisp will ship the abortion medicine, ibuprofen, anti-nausea pills, and a pregnancy test (used to verify if the abortion was successful) to your door. It will also provide 24-hour support as needed, in addition to two wellness check-ins following the treatment. In order to use the service, you must be at least 18 years old, less than 10 weeks pregnant, and live in California, Colorado, Connecticut, Illinois, Maine, Maryland, New Mexico, New York, or Washington.

The fight for abortion access remains in limbo, especially in states with lawmakers set on banning and restricting abortion access, regardless of if they're obtained through mailed medication or at an in-person clinic. And given that an estimated 1 in 4 U.S. women will have an abortion by age 45, safe access is critical.

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