The 13 States Where You Can Access Abortion By Mail

Abortion by Mail Graphic
By Katie Foley

While anti-choice governors and attorneys general have taken advantage of the widespread sense of urgency to contain the COVID-19 pandemic to yet again limit abortion access, abortion advocates have pushed for telemedicine prescriptions for mifepristone and misoprostol, the drugs commonly used together in medical abortions. Allowing physicians to prescribe these medications via telemedicine would save patients a trip to the clinic, allowing them to further respect social distancing measures.

Currently, easy access to mifepristone is blocked by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). The REMS program was created to restrict the circulation of potentially dangerous medications. In the case of mifepristone, REMS requires that it be dispensed by a “clinic, medical office, or hospital under the supervision of a healthcare provider registered with the drug manufacturer,” and for the patient to receive counseling about the pill’s risks. From a medical standpoint, these restrictions are unnecessary–the American College of Obstetricians, the American Medical Association, and the American Association of Family Physicians all agree that medication abortion can be safely and effectively administered without REMS restrictions.

Four days ago, a coalition of 21 state attorneys general sent a letter to urge the Trump administration to waive REMS restrictions in order to mitigate new and increasing barriers to abortion access stemming from the COVID-19 crisis, such as financial hardship, travel restrictions, and strain on the medical system. Of course, the Trump administration is unlikely to take any action that would possibly expand access to abortion. Nevertheless, pro-choice advocates are working at the state level to increase access during the COVID-19 crisis. In 2008, the Iowa Planned Parenthood clinic system reached a milestone when its leaders established a telemedicine abortion program in which patients with no nearby physician could teleconference with a doctor and pick up their prescription at a more accessible clinic. This program has since been replicated and now operates in a similar way in Alaska, Minnesota, and Maine.

Gynuity Health Projects, a research organization operating under FDA approval by the Obama administration, has gone a step further and is sending medication abortion directly to patients in the mail. TelAbortion allows patients to request medication abortion via video conference and receive the pills in the mail. Patients only leave their homes to complete any required lab work at a nearby medical facility. TelAbortion is currently operating in 13 states, including Colorado, Georgia, Hawaii, Illinois, Iowa, Maine, Maryland, Minnesota, Montana, New Mexico, New York, Oregon, and Washington. While expansion to serve patients in other states is unlikely given the current administration, Gynuity Health Projects’ work is a model solution for prioritizing abortion access in the midst of a pandemic or other widespread crisis.

In fact, the U.K. government has recently adopted a similar program. On March 30, the same day 21 attorneys general urged President Trump’s administration to expand access to abortion in the U.S., the U.K. Department of Health and Social Care enacted a temporary policy change to allow patients to take both mifepristone and misoprostol in their own homes, waiving the existing requirement that patients take the first dose at a clinic. Abortion activists in Europe have praised this decision and urged other European countries to take similar steps, and just earlier today, Ireland became the first country to permit telemedicine abortion services in response to COVID-19 despite having only legalized abortion last year.

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