Abortion-Pill Providers Prepare to Reach Patients in Restrictive States

Planned Parenthood and other abortion providers said they are expanding clinical operations in states where abortion is expected to remain legal. “Those who have enough privilege and resources to travel, they’ll do that,” said

Meera Shah,

chief medical officer of Planned Parenthood Hudson Peconic in New York.

After Texas passed legislation last year banning abortion after about six weeks, neighboring states reported a rush of patients. Many people sought medication abortions through telemedicine providers as well. Minneapolis-based telemedicine provider Just the Pill served 900 patients in the first four months of this year following the passage of the Texas law, compared with 1,300 in all of 2021, said

Julie Amaon,

Just the Pill’s medical director. Now Just the Pill is expanding to handle more requests from patients if Roe v. Wade is overturned.

“We’ve been crazy busy,” Dr. Amaon said.

Medication abortion accounts for the majority of U.S. abortions, according to the Guttmacher Institute, a policy group that supports abortion rights and tracks abortion statistics. Abortion pills are prescription-only in the U.S. Two medications—mifepristone and misoprostol—are typically used in a medication abortion regimen. Misoprostol can be used alone if mifepristone is unavailable. Patients can legally obtain the drugs at clinics or through U.S.-based telemedicine providers like Just the Pill, Hey Jane and Choix.

Until the Covid-19 pandemic, the Food and Drug Administration required patients to collect mifepristone from a clinic. The restriction was lifted last year. More than 30 states, however, require a clinician to see a patient in person before prescribing mifepristone. States including Texas and Indiana have partial bans on abortion pills.

Patients in states with restrictions have sometimes found workarounds, providers said. Dr. Amaon said Just the Pill patients in South Dakota have traveled to neighboring Wyoming for telemedicine consultations and to collect abortion pills from P.O. boxes or courier drop boxes. Wyoming is among the 13 states with laws that would effectively ban abortion immediately were Roe v. Wade overturned. “We will serve in these states right up until the day we can’t,” Dr. Amaon said.

Abortion-rights advocates said U.S.-based clinics and telemedicine providers might not be able to meet the needs of all patients seeking abortions, particularly those who can’t travel for care. U.S.-based telemedicine providers could be prosecuted for providing abortion consultations or sending abortion pills to patients in states where abortion is restricted, legal experts said.

Lawmakers in some states that support abortion rights are considering laws to protect providers from prosecution. Connecticut recently passed a bill including a clause that would prevent abortion providers from being extradited to other states.

Patients in many states where abortion is restricted are expected to have to leave their state to receive telemedicine care from a U.S. provider and to pick up abortion pills, abortion-rights advocates said. Alternatively, they said, patients could procure abortion pills from providers overseas.

“What we’ve already seen is an incredible surge in requests,” said

Rebecca Gomperts,

a physician and founder of Aid Access, a nonprofit telemedicine abortion provider based in Austria.

Aid Access patients receive a telemedicine consultation and a prescription for abortion pills that are shipped to the U.S. from India. The pills are identical in composition to FDA-approved mifepristone and misoprostol, Dr. Gomperts said.

Abortion pills from Aid Access and other overseas pharmacies are typically shipped in unmarked packaging, making them hard for law enforcement to detect, abortion-rights advocates said. Still, legal risks for patients remain, said

Jill E. Adams,

executive director of If/When/How, a reproductive-rights advocacy group. Her organization has represented clients facing charges related to self-managed abortion, including some who have obtained pills from Aid Access and online pharmacies based internationally. Ms. Adams said that clients haven’t been charged specifically for obtaining abortion pills but the procurement of the drugs has been used as evidence against them.

FDA rules generally don’t allow the importation of prescription drugs or distribution of drugs that it hasn’t approved. The FDA in 2019 sent a warning letter to Aid Access for distributing drugs the agency hadn’t approved in the U.S. Aid Access said in a letter of response that the FDA was limiting constitutionally protected access to medical abortions. The FDA didn’t pursue further action. Dr. Gomperts said she doesn’t intend to curtail Aid Access’s work if Roe v. Wade is overturned.

The FDA said the sale of unapproved mifepristone for abortion bypasses important safeguards designed to protect patients’ health. Drugs that have circumvented regulatory safeguards may be contaminated, counterfeit, contain varying amounts of active ingredients or contain different ingredients altogether, the agency said.

Information on abortion pills sold by online pharmacies based overseas is limited. Plan C, an abortion-pill advocacy group, said it regularly evaluates the online pharmacies listed on its site by buying and conducting lab tests on their products.

A 2017 study funded by Gynuity Health Projects, a nonprofit research group focused on abortion and other reproductive-health services, evaluated the chemical composition of mifepristone and misoprostol pills from 18 online pharmacies based outside the U.S. The mifepristone pills all contained about 200 milligrams of the active ingredient. The misoprostol pills, labeled as containing 200 micrograms, contained levels ranging from 34 micrograms to over 200 micrograms of misoprostol.

A regimen of 200 milligrams of mifepristone and 400 or more micrograms of misoprostol is typically used to terminate pregnancies under 10 weeks, according to the Guttmacher Institute.

“Most people are able to safely and effectively manage their abortions using mifepristone and misoprostol when they acquire these medications from reliable sources,” said

Nisha Verma,

a fellow at the American College of Obstetricians and Gynecologists. “Evidence also indicates that people can safely carry out a medication abortion without direct doctor supervision when they have access to accurate information, reliable medications and support if a rare complication arises.”

—Denise Roland contributed to this article.