- A new service called Aid Access will allow women in the US to receive medical abortion pills by mail, The Atlantic reported Thursday.
- A medical abortion consists of two drugs -mifepristone and misoprostol – that end a pregnancy.
- Aid Acess screens women online to make sure they’re eligible for the pills. Then a pharmacy sends them by mail.
- Research shows these types of abortions are generally safe, though there is a small risk for complications.
A new service called Aid Access will help women in the US get medical abortion pills by mail, according to a report published Thursday in The Atlantic.
The service was launched earlier this year by Rebecca Gomperts, a Dutch medical doctor. Gomperts previously founded an organisation called Women on Web, which for years has facilitated medical abortions for women living in countries where it’s illegal, The Atlantic reported.
Medical abortion typically involves two drugs – mifepristone and misoprostol – that are taken in succession to end an early pregnancy. When it’s done before the eighth week of pregnancy, it’s about 97% effective, according to Planned Parenthood.
Abortion pills are already sold online, but many sites that sell the pills lack any type of doctor oversight, according to Plan C, an organisation that provides information on self-managed medical abortion. Planned Parenthood also warns that abortion pills purchased online may not contain the right medicines or could even be fake.
But Aid Access offers a safer, more reliable way of obtaining the pills. The service screens women with an online questionnaire to make sure they are eligible for a medical abortion and not too far along in their pregnancy. (The pills become less effective after the nine-week mark.)
Gomperts then reviews the answers, writes each eligible woman’s prescription, and sends it to a pharmacy in India, which will ship the pills to the US. Women receive instructions on taking the pills, and if they have questions, they will be able to Skype with Gomperts or call her help desk, The Atlantic report said.
In an interview with INSIDER, Gomperts said she also refers women to other relevant services they may need, such as psychological counseling for victims of rape.
The cost of the consultation and pills is $US95, but the Aid Access website says it will try to help those who can’t pay. That price point may represent significant savings for some women, since medical abortions can cost up to $US1,000 in a traditional medical setting, according to Planned Parenthood.
Women on Web did not previously serve American women because Gomperts worried that the anti-abortion movement in the US would try to shut down the organisation, The Atlantic reported. But she was inundated with requests from the US, so she decided to start Aid Access as a separate service to protect Women on Web from any risk.
Aid Access actually launched back in April but Gomperts has “kept it quiet,” until now, The Atlantic report added. So far she estimates she’s prescribed abortion pills for 600 women.
It can be difficult to get an abortion in the US
Abortion is legal in the US, but it can be difficult for some women to get one. First, it may be prohibitively expensive. Some state laws also require women to get counseling, inform their parents if they’re minors, or endure waiting periods before they can get an abortion, according to the American College of Obstetricians and Gynecologists (ACOG). And a 2017 analysis by the Guttmacher Institute found some women in the US must travel long distances – more than 100 miles, in some parts of the country – in order to access abortion.
“[Aid Access] is not intended to replace any existing [abortions] services at all. That’s not the intention. The intention is to be a backup for women that cannot access the other services that exist,” Gomperts told INSIDER. “Abortion should be much easier to access in the US than it is now.”
There may be some legal risk associated with getting abortion pills online
Many may wonder about the legality of the service.
In an interview with INSIDER Gomperts explained that she and the pharmacy she uses comply with the laws where they operate (none of Aid Access is actually based in the US, she added).
But it is possible that obtaining abortion pills online may carry some legal risk for women in the US, according to Jill Adams, chief strategist at The SIA Legal Team, a nonprofit organisation that offers legal help to women who are questioned, arrested, or jailed in connection with abortions.
“There are thousands of restrictions on abortion that vary from state to state. But the legality of any particular act of self-managed abortion in any particular state is dictated by a very complex cobweb of intersecting criminal civil, and regulatory laws,” Adams told INSIDER.
A report from The SIA Legal Team found that seven US states have laws criminalizing self-induced abortion, for example. Even in states that don’t outright prohibit it, there may be different laws that “increase the threat of criminalization” for women who self-manage abortions, Adams added. The organisation’s research has also uncovered 20 cases in which people who self-managed abortions (or helped another person do so) were arrested.
But Adams also said the statues outlawing self-induced abortion are antiquated, predate Roe v. Wade, and could be argued unconstitutional.
“I think it’s really important to start from the premise that abortion is legal in the US and protected by the federal constitution, and enjoys even greater protections under many state constitutions,” she said.
In short: There’s no straightforward, definitive conclusion.
“People who end their own pregnancies deserve to do so safely, with dignity, and free from the threat of arrest,” she said. “It’s tricky…We want people to understand that there is this option available that many people have used but that it’s not risk-free.”
There is a risk of complications, but research shows self-managed abortion is generally safe
The first pill in a medical abortion, mifepristone, blocks progesterone, a hormone that’s needed to continue a pregnancy. The second, misoprostol, is taken six to 48 hours later and causes cramping and bleeding to empty the uterus, Planned Parenthood explains.
There’s evidence that it’s “safe and effective” to self-manage a medical abortion without direct supervision by a doctor, according to a World Health Organisation (WHO) report on safe abortion care. The WHO says it recommends this option “in circumstances where women have a source of accurate information and access to a health-care provider should they need or want it at any stage of the process.”
A 2018 study followed 1,000 Australian women who were screened online by doctors and mailed abortion pills – a process sometimes called telemedicine abortion. Only 5% needed face-to-face medical care after using the pills. Another study compared about 10,400 American women who got in-person medical abortions with about 8,700 who got telemedicine abortions. In both groups,less than 1% of patients reported any adverse events.
And in 2017, a group of researchers analysed 1,000 women who used Gomperts’s Women on Web service to obtain abortion pills. Again, the number of serious complications was low. Only 2.6% of the women said they’d gotten complications requiring antibiotics and 0.7% reported getting a blood transfusion as a result of using the pills.
Complications of a medical abortion may include blood clots in the uterus, excessive bleeding, infection, or an allergic reaction to one of the drugs, according to Planned Parenthood. There’s also a chance the pills won’t work and the pregnancy won’t end. Women who experience heavy bleeding, large blood clots, cramps that don’t get better with pain medication, fever, weakness, nausea, vomiting, or diarrhoea, should seek medical care.
“An abortion with pills is exactly the same as a miscarriage, and so as in the miscarriage, there is a very slight risk that there might be some complications,” Gomperts told INSIDER. “It’s very small. But … women need to know when they have to go in for medical care.”
The Aid Access website says it’s “absolutely necessary” to be within 60 minutes of medical help while undergoing a medical abortion, should these complications arise. But they are still very rare.
“After more than 15 years of use in the US, we know medication abortion is extremely safe and effective,” Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at UCSF, said in a statement about the launch of Aid Access. “When it comes to self-managing an abortion, research shows that when people have accurate information and access to high-quality medication, they can use the abortion pill safely and effectively on their own.”
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