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A new service will help women in the US get the abortion pill by mail

A new service will help women in the US get the abortion pill by mail

A new service aims to help US women obtain medical abortion pills.

A new service aims to help US women obtain medical abortion pills.
Charles McQuillan/Getty Images
  • 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 organization 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 organization 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’ll 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.

Dr. Rebecca Gomperts.

Dr. Rebecca Gomperts.

The cost of the consultation and pills is $95, 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 $1,000 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 organization, 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 organization 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 organization’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 second pill in a medical abortion causes cramping that empties the uterus.

The second pill in a medical abortion causes cramping that empties the uterus.
Daisy Daisy/Shutterstock

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 Organization (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 analyzed 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 diarrhea, 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.”

Visit INSIDER’s homepage for more.

7 maps and charts show the state of abortion access in America

7 maps and charts show the state of abortion access in America

This map shows what abortion policies states would enact if Roe v. Wade were overturned.

This map shows what abortion policies states would enact if Roe v. Wade were overturned.
Samantha Lee/Business Insider

The landmark Supreme Court case Roe v. Wade and subsequent rulings upholding it have granted Americans the right to abortion since 1973, but the reality of that right varies dramatically from state to state.

Since Roe became the law of the land, individual states have found dozens of ways to make it as difficult as possible for patients to actually access the procedure.

From strict regulations on clinics and bans on abortion after a certain number of weeks, to requiring patients to receive counseling and undergo waiting periods, these laws have tested the limits of Roe – with some ending up in federal court.

If President Donald Trump’s nominee Brett Kavanaugh is confirmed, the Supreme Court will have a solidly conservative majority, causing many abortion rights advocates to fear that such a makeup would overturn Roe altogether.

The more likely scenario, according to legal experts, is for the high court to chip away at abortion rights by ruling in favor of the state-level restrictions that reach their .

These seven charts and maps illustrate what abortion access in America actually looks like today, and what could happen if Roe fell.

Abortion clinics per state, 2014

Shayanne Gal/Business Insider

In the decades since Roe, individual states have enacted a slew of restrictions to make it as difficult as possible for abortion clinics to operate.

Targeted Restrictions on Abortion Providers, or TRAP laws, impose very specific regulations on clinics. Oftentimes, these restrictions are so expensive that the costs of implementing them cause many clinics to close down altogether.

These include requirements on the width of corridors, the size and equipment of procedure rooms, and mandating that clinics have admission privileges at local hospitals, even though less than 0.5% of abortions result in complications.

Research has tracked the number of abortion clinics dropping after states have passed TRAP laws. Five states now have just one remaining abortion clinic.

Sources: Guttmacher Institute, Business Insider, Texas Policy Evaluation Project

Percentage of counties without a known clinic, 2014

Samantha Lee/Business Insider

The Supreme Court struck down one of the most extreme TRAP laws, Texas’ HB2, in a 5-3 vote in 2016. But despite that, over 20 states still have such laws on their books.

A closer look at the county level shows stark disparities in abortion access across the country. There are now 16 states where 95% of counties do not have an abortion clinic.

Sources: Business Insider, National Center for Biotechnology Information

Percentage of women aged 15–44 living in a county without a clinic, 2014

Samantha Lee/Business Insider

By causing clinics to close down, TRAP laws have the consequence of making patients further and further to get to a clinic, especially in states that require patients to make multiple trips to the clinic and undergo a 24-to-72 hour “waiting periods.”

According to a 2017 study from the Guttmacher Institute, one in 5 American women have to travel at least 43 miles to reach their closest abortion provider. Between 2011 and 2014, the distance required to reach a clinic increased in seven states.

Researchers found notable increases in distance to a clinic in Missouri and Texas, states that had introduced TRAP laws.

“Increased travel distance means increased costs for transport, overnight stay, lost wages from time off work, and childcare,” wrote Dr. Ushma Upadhyay, a professor of obstetrics and gynecology at the University of California.

She continued: “For a woman who is economically disadvantaged, having to travel a long distance could put an abortion out of reach, leading her to carry an unwanted pregnancy to term.”

Sources: National Center for Biotechnology Information, Guttmacher Institute, The Lancet Public Health

How the phases of pregnancy and fetal development line up with abortion ban laws

Skye Gould/Business Insider

In the past several years, states have made many attempts to restrict patients from getting abortions after a certain number of weeks – oftentimes before a woman even knows she’s pregnant.

In December 2016, the Ohio state legislature passed a “heartbeat bill” that would have banned abortions after six weeks, or when a fetal heartbeat can be detected, even though many women don’t know they’re pregnant until after that point. Gov. John Kasich vetoed the bill and signed a 20-week ban into law on the same day.

Other states have tried to ban dilation & evacuation (D&E), the method commonly used to perform abortions after 14 weeks. The surgical procedure is usually used in late-term miscarriages and abortions to remove the fetal tissue as safely as possible. They account for less than 0.5% of all abortions.

Prohibiting D&E abortions is effectively a ban on all second-trimester abortions, landing such bans in murky legal territory.

In Roe v. Wade, the Supreme Court didn’t specify when abortions were legal, deciding at the time to vaguely make it unconstitutional to outlaw them up until the fetus was “viable,” since the science hadn’t (and still hasn’t) determined at the time when that was, medically speaking.

Texas and Alabama’s D&E bans have reached federal appeals courts, and the Supreme Court could hear them in the upcoming term.

Sources: Business Insider, Politico

Percent of adults in 2017 who say abortion should be

Samantha Lee/Business Insider

While the last decade has seen an explosion in abortion restrictions, Americans as a whole haven’t become more anti-abortion in the past 20 years.

Currently, 58% of adults say abortion should be legal in all or most cases, while 40% say it should be illegal in all or most cases. Those numbers are almost exactly the same as they were back in 1995.

Source: The Pew Research Center

Political party and ideology who think abortion should be

Samantha Lee/Business Insider

Support for abortion has long been a partisan issue, with support for abortion in all or most cases being highest among liberal Democrats and lowest among conservative Republicans.

But over a quarter of those who identify as conservative Republicans now believe abortion should be legal in all or most cases.

Despite the partisan divides, bipartisan support for Roe v. Wade is at a new high. A Wall Street Journal/NBC News poll released July 23 found that 71% of Americans and 52% of Republicans polled believed that Roe v. Wade should not be overturned.

Source: Pew Research Center, NBC News

What would happen state-by-state if Roe v. Wade fell

If the Supreme Court does overturn Roe, the issue of abortion will go back to the states. Elizabeth Nash, a senior state issues manager at the Guttmacher Institute, explained all the possible outcomes to Business Insider.

Four states passed “trigger laws” after Roe was decided, which would automatically make abortion illegal as soon as the decision is overturned.

But 10 states have pre-Roe abortion bans or restrictions still on their books that are currently un-enforceable because they violate Roe. Unlike trigger laws, Nash explained, these bans wouldn’t go back into effect immediately. A government actor like an attorney general or a legislature would have to put them back in place.

Seven states have passed decrees that are “without the force of law” expressing their intent to limit abortion to the greatest extent permitted by federal law if Roe falls, Nash said.

On the flipside, nine states have laws on the books that ensure abortion stays legal within their borders.

Sources: Guttmacher Institute, Business Insider

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