Abortion is a health care issue, not a legal one — allow pills by mail

Abortion foes may be reveling at the thought that the nine U.S. Supreme Court justices may turn back the clock to 1972, when abortion was not a nationally protected health care service.

The high court has agreed to take up a Mississippi case, likely next year, and, just this week, Texas’ governor signed a law that essentially bans abortion in the state. The cases have ramifications for millions of Americans.

But let’s be serious: Medical care over the last half-century has progressed, and there is no turning back.

In the last year alone, clinicians across the nation demonstrated that essential health care services, including abortion, can be delivered outside a traditional office setting using video, telephone, online platforms and the U.S. mail.

Under pandemic guidelines and in a small window of time, with relaxed Food and Drug Administration rules around abortion pills and medical care by telemedicine, hundreds of primary care and women’s health clinicians rallied together to meet the needs of patients.

My research team at the University of Washington School of Medicine conducted one study demonstrating that staff and providers in a variety of practice settings were able to safely, effectively screen and care for patients seeking abortion with telehealth visits and snail-mailing the abortion pills mifepristone and misoprostol to patients.

We showed in another study that, in just six months, three family physicians served hundreds of patients via virtual care. About 85% were less than eight weeks pregnant when they requested and received care. According to our results, a single primary care provider using telehealth could serve an entire state, especially in rural areas where the services are scarce.

Additionally, although many of our study subjects lived in large metropolitan areas with established abortion clinics, they sought abortion services by telemedicine, largely, it seems, to keep the matter private and to avoid social stigma.

For more than 20 years, ever since the Food and Drug Administration approved mifepristone, the possibility of safely, effectively ending a first-trimester pregnancy with pills has existed. Mifepristone has a proven safety record, and is safer than many medications I routinely prescribe and pharmacies dispense, including hypertension medications, antibiotics, insulin and opioids.

Yet access to abortion pills has been severely restricted. For more than two decades, anti-choice government bureaucrats have kept mifepristone out of pharmacies, requiring clinicians to order, store and dispense it “in person” in a clinic or hospital. In 2020, this rule was relaxed after a lawsuit was brought by the American Civil Liberties Union to allow the shipment of the pills directly to patients or through an online pharmacy to avoid the risks of clinic visits during the COVID-19 pandemic.

Restrictions on dispensing and mailing the drug were once more imposed in January, only to be reversed again by the FDA in April.

Abortion is a health care issue, not a legal one. A recent survey found that 69% of the population favors keeping Roe v. Wade in place.

Abortion is one of the most common medical services for which patients seek care, with 1 in 4 women terminating at least one pregnancy in their lifetime. Efforts by individual states to limit the number of clinics, to jail women for pregnancy-related issues or use other means to block access to abortion care do not reduce abortion rates.

It does, however, force segments of our society, namely poor and marginalized persons, to delay their care, which statistics show leads to greater complications and death. In essence, legislative efforts to limit access to safe, legal abortion services is counter to our nation’s goals of social justice, and improved health and wellness for all.

In June, the FDA will conduct a review of its restrictions on mifepristone. Medication abortion by telemedicine allows patients to seek care earlier in pregnancy and promises to address America’s glaring health care disparities.

This is the FDA’s moment to do the right thing — to treat all Americans equally and fairly by allowing mifepristone to be prescribed by clinicians and dispensed in pharmacies or through the mail, like most other medications.