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 In the year before many of these new restrictions passed
Republican-controlled state legislatures, over 20,000 U.S. women
sought the pills online from providers willing to defy U.S. federal
rules over sale of the drugs that induce miscarriage.
One of them was Kayla, a 24-year-old Mississippi mother of two who
terminated a pregnancy in January. She and her husband decided they
could neither afford to raise another child nor get an abortion at
the nearest clinic in Memphis, Tennessee.
"I wouldn't know what to do if I didn't have access to that," said
Kayla, who asked to be identified only by her first name. "I would
probably right now be six months pregnant and miserable. It was my
lifesaver."
Abortion is one of the most divisive issues in U.S. society.
Opponents cite religious beliefs about the sanctity of life, while
abortion-rights activists say bans rob women of control over their
bodies and futures.
The U.S. Food and Drug Administration has imposed strict rules on
distribution and use of abortion pills, but state pharmaceutical
regulators said they have no effective way of tracking and policing
online orders from foreign doctors and pharmacies.
"We would only know that if someone were to report it to us," said
Larry Hadley, pharmacy board director in Kentucky, one of six states
that passed a law this year banning abortion after six weeks, often
before a woman knows she is pregnant.
Pharmacy board officials in Alabama, Ohio, Louisiana, Missouri,
Georgia and North Dakota also said they were not aware of shipments
of the drugs from unlicensed, foreign providers or how they would
take action against them.
From March 2018 through March 2019, some 21,000 U.S. women sought
the abortion-inducing pills misoprostol and mifepristone from the
Austria-based website AidAccess.org, according to a University of
Texas at Austin study.
"It's reasonable to expect that as states make it even more
difficult for people to access clinic-based abortion care, more
people will seek alternatives including self-managed abortion," said
Jill Adams, executive director of reproductive rights legal group
If/When/How.
In another measure of growing interest PlanCPills.org, a website
that rates the safety of online pill providers, said the number of
visitors has surged to as high as 8,000 people a day, up from a
baseline of about 1,000 over the past few months.
FDA WARNINGS
The FDA has sent warning letters to foreign online providers,
threatening seizure and injunctions unless they stop selling the
abortion pills to American women.
"We remain very concerned ... because this bypasses important
safeguards designed to protect women's health," an FDA spokesman
said in an email.
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But some medical experts describe FDA regulations of these drugs as
excessive. They cite studies published in medical journals showing
that they pose a relatively low health risk and cause far fewer
deaths among U.S. women than natural childbirth.
There is currently only one FDA-approved product, which the agency
requires be dispensed in a medical office, clinic or hospital.
The pills, typically taken in the first trimester of pregnancy, thin
the uterine lining to prevent the embryo from staying implanted and
cause the uterus to contract, inducing a miscarriage. They should
not be confused with the "morning after" pill that prevents
pregnancy.
Risks from the abortion pills include possible heavy bleeding and,
in rare cases, the abortion may fail, requiring follow up with
surgical abortion, according to the Mayo Clinic, a prominent U.S.
hospital system.
Of the 3.7 million women who took the FDA-approved brand of
mifepristone to terminate a pregnancy between September 2000 and
December 2018, 24 died from complications, according to FDA records.
AidAccess founder Rebecca Gomperts, a medical doctor based in
Austria, received a letter from the FDA in March warning her to stop
prescribing abortion pills. She has ignored it.
"I am responding to an urgent medical need of my patients," Gomperts
said in a phone interview. "I have a medical duty to do so and I do
it."
The abortion pills are typically priced at a fraction of the
hundreds of dollars for a clinic abortion. Gomperts occasionally
waives the cost entirely for women who cannot afford it.
Gomperts said she writes prescriptions for the pills for women who
are less than nine weeks pregnant that are then filled by an Indian
pharmacy. About three out of four women who contact her opt against
the pills for a variety of reasons, she said.
Officials in Arkansas, Indiana, Tennessee, Utah and Mississippi
declined to comment or did not respond to calls.
In Texas, where the number of abortion clinics has shrunk by nearly
half since 2013, Kerstin Arnold, general counsel for the Texas State
Board of Pharmacy, said the state had no way of regulating
pharmacies outside the United States.
"I don't even know where we would go trying to enforce that," she
said.
(Reporting by Gabriella Borter; Editing by Scott Malone and Bill
Berkrot)
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