Just this week, the administration asked the U.S. Supreme Court to reverse a lower court ruling allowing women to receive telemedicine abortion services and pills delivered by mail during the COVID-19 pandemic. If Trump wins, millions of women across the U.S. risk losing this essential health care.
I met one such woman in my clinic a few months ago. She was a teenager, and she was tearfully anxious. She was seeking an abortion and had traveled over three hours from Eastern Washington to receive care in a Seattle clinic. She was unable to find a clinic closer to home that would offer her the treatment she was seeking.
With telemedicine and the recent ruling that allows women to receive abortion pills by mail, we can expand the reach of reproductive services into rural areas. My teenage patient would have been able to speak with a physician and obtain pills without the added burden of traveling long distances and potentially exposing herself to COVID-19.
In order to understand the current debate, it is important to know the history of abortion pill regulation.
Medication abortion is a common, safe, and effective way to end an early pregnancy. Approximately 340,000 pregnancies are ended with abortion pills in the United States each year. The regimen involves taking two pills: mifepristone followed by misoprostol a day later. These pills essentially induce a miscarriage, which occurs in the privacy of a person’s home.
The Food and Drug Administration (FDA) specifically targeted mifepristone after its approval in 2000 using the “Risk Evaluation and Mitigation Strategy” (REMS) that also governs certain drugs with safety concerns, like methadone, which is used to treat opiate addiction. These restrictions mandated that mifepristone be administered in clinics or hospitals, instead of picked up at retail pharmacies. They also mandated that physicians be certified by the drug company and attest to their qualifications.
To be fair, when mifepristone was first approved, we were still collecting data about its safety outside of a research context. We now have 20 years of data attest to its safety profile. In fact, the risk of death from pregnancy is about 14 times higher than the risk of death from an abortion in the first trimester.
Today, the REMS restrictions are just another onerous and unnecessary barrier to reproductive services. Clinics, unlike pharmacies, rarely function as dispensaries and maintaining drug supply is expensive. Other restrictions are simply redundant. For example, it is already standard of care for physicians to prove their qualifications with state licensing, multiple board examinations, and years of training.
The FDA loosened restrictions in 2016, allowing women to take mifepristone in their own homes after obtaining the pill in-person at a health care facility. Earlier this year, when the ACLU and American College of Obstetricians and Gynecologists filed suit, they claimed that the REMS “requirement imposes unnecessary COVID-19 risks and other burdens by forcing patients to travel to one of these clinical settings solely to pick up the medication and sign a form, even though, based on safety data, the FDA already permits patients to swallow the pill later at home.” Meanwhile, even opioids like methadone, which were previously administered in person, are now available for mail delivery or pharmacy pickup during the COVID-19 pandemic.
Pharmacists also agree. In the May 2018 Journal of the American Pharmacists Association, they concluded that “mifepristone no longer fits the profile of a drug that requires a REMS.” Meaning, if you can mail someone their methadone, you can certainly mail them mifepristone. By attempting to reverse the recent ruling in favor of mailed mifepristone, the Trump administration is undermining the expertise of our health professionals and scientists and attempting to chip away at our health care. Don’t let them.
Monica Agarwal, Alexa Lindley, and Emily Godfrey are family physicians. The opinions expressed in this op-ed are the personal views of the writers and do not represent the position of UW Medicine.
Image credit: Shutterstock.com
