Abortion Pills Access Becoming Harder in Places Despite FDA Stance

Opposition to medical abortion pills is putting the drug out of many patients' reach, even though the Biden administration has been making efforts to make the pills more accessible by allowing retail pharmacies to sell them directly to patients in states where abortion is legal.

Earlier this month, the Food and Drug Administration announced it will allow pharmacies to offer the pills to consumers, but even though mifepristone was approved by the FDA in 2000 for use for early, nonsurgical abortions, states with strict abortion bans are limiting the drug's availability, particularly through restrictions on who can prescribe the drug or by banning it, reports The Hill.

The Guttmacher Institute, an abortion rights group, notes that in 18 states, a clinician who prescribes a medically induced abortion must be there physically when the patient takes the medication, which means the use of telemedicine to obtain the pills is prohibited.

In Texas, medication abortion is banned starting at the seventh week of pregnancy, with Indiana banning it at 10 weeks. Mifepristone has been approved for use for up to 10 weeks.

"We have decades of evidence that medication abortion and mifepristone, in particular, is safe, it is effective, and so the FDA did what it's designed to do," Jamila Perritt, an obstetrician-gynecologist in Washington, D.C., and president and CEO of Physicians for Reproductive Health commented. "The challenge is that access to abortion, and medication abortion specifically, is not solely tied to medical care or medical decision-making in this country."

Federal law takes precedence over state laws in most incidences, but it is not clear if that is the case with states with abortion plans, and Rachel Rebouche, the dean of Temple Beasley School of Law, said the matter of abortion pills is a "somewhat unique situation."

"States don't typically try to ban drugs that the FDA approved," she said while acknowledging that even though states can regulate medical practices, there is a question of intent when it comes to mifepristone.

"Are they making a judgment about the safety and efficacy or are they banning it because of moral grounds?" she asked.

Meanwhile, the Department of Health and Human Services did not respond to questions about any plans to challenge state restrictions, but legal experts and advocates said the different state laws mean uncertainty for both patients and providers.

Major retailers CVS and Walgreens said, after the FDA's announcement, that they will allow their pharmacists to dispense mifepristone but only in states without near-total abortion plans.

"We are working through the registration, necessary training of our pharmacists, as well as evaluating our pharmacy network … and will dispense these consistent with federal and state laws," a Walgreens spokesman said.

Perritt said she is most concerned about the most vulnerable people lacking access to abortion, while it will remain accessible to wealthier people.

"The reality is that whatever the states do, whatever the federal government does, people with means and resources will always be able to access abortion," she said. "It was like that before Roe was decided in '73. It was like that during the 40-plus years that Roe was around, and we will continue to see that happen in this current iteration," Perritt said.

But even with access becoming difficult in some places, New York City Democrat Mayor Eric Adams announced this week the city is offering free medication abortion pills at four city-run health clinics.

Wednesday, the New York City Department of Health and Mental Hygiene clinic in the Bronx began offering the medication and according to the governor's office, the medication will also be offered for free at clinics in Brooklyn, Manhattan, and Queens, to help patients who may have economic or insurance issues.

"No other city in the nation or the world has a public health department that is providing medication abortion. We are the first," Adams said. "It is long overdue that we break taboos and make New York City a model for the future of women's healthcare. We are going to build a city that is here for all women and girls."