As abortion becomes increasingly inaccessible in parts of this country, a Dutch physician is defying the U.S. Food and Drug Administration’s order to quit providing abortion pills using the internet and the mail.
The doctor, Rebecca Gomperts, has for years run Women on Web, a Netherlands-based nonprofit that ships mifepristone made in India to women in countries where abortion is illegal. Last summer, she launched Aid Access to provide the same pills to U.S. customers.
Aid Access claims to be growing quickly, with more than 21,000 U.S. orders in the last six months, according to the Guardian newspaper. The organization filled between a third and half of the requests, despite shutting down for 10 weeks after the FDA sent a warning letter on March 9.
The warning letter said Aid Access was violating U.S. law and endangering customers by selling “misbranded and unapproved new drugs."
In response, the organization’s Idaho-based lawyer, Richard Hearn, who is also a physician, sent a letter to the FDA on May 16. ″Because access to medical abortions in the U.S. has been so restricted by the FDA," he wrote, “women have been forced to attempt to exercise their right to abortion by way of the Internet.”
Aid Access resumed service the next day.
The FDA declined to discuss its next step. “We cannot comment on a potential future action at this time,” the agency emailed, “but we remain very concerned about the sale of unapproved mifepristone for medical termination of early pregnancy on the Internet, because this bypasses important safeguards designed to protect women’s health.”
The abortion-pill regimen, which is effective through the first nine weeks of pregnancy, actually involves two drugs. Mifepristone, sold in the U.S. by Danco Laboratories and branded Mifeprex, disrupts the pregnancy, then misoprostol triggers uterine contractions and expulsion of the grape-size fetus.
The FDA requires women who want the regimen to make two visits to the doctor, and they can’t get mifepristone from pharmacies. It can only be dispensed in clinics or medical offices by specially certified health-care providers.
Aid Access, in contrast, provides pills after a woman consults online with the prescribing doctor and gets a blood test. She receives instructions for taking the drugs, what to expect, and when to see a doctor if a problem occurs.
Numerous other international websites ship abortion pills — without prescription or any medical oversight. That’s why a group of researchers who support abortion rights created Plan C, a website with a “report card” that rates such websites on product quality, price, and shipping time.
"The combination of very safe and effective medication abortion, and the pervasiveness of global commerce, make Internet access virtually unstoppable,” said public health researcher Elisa Wells, codirector of Plan C.
She believes the proliferation of ultra-restrictive state abortion laws is fueling demand for online abortion pills. Earlier this month, Plan C’s web traffic spiked from 1,000 hits a day to eight times that many after Alabama’s governor signed a law that bans abortions in almost all cases, including rape or incest.
Governors in Kentucky , Mississippi , Ohio, and Georgia have recently approved bans on abortion once a fetal heartbeat is detected, which can happen in the sixth week of pregnancy, before many women know they’re pregnant. Missouri’s governor on Friday signed a law outlawing abortions after eight weeks. Other states are considering similarly restrictive measures.
Although the laws are not being enforced because of legal challenges, abortion foes hope this sets the stage for the U.S. Supreme Court to revisit and even overturn Roe v. Wade, the landmark 1973 case that legalized abortion nationwide.