The Food and Drug Administration recently announced it would relax restrictions on a stringently regulated medication used to induce abortions at up to 11 weeks of pregnancy.
The drug, mifepristone — sometimes called “the abortion pill” — can be used in combination with another medication, misoprostal, to terminate early-term pregnancies and for miscarriage management.
In April 2021, the Biden administration eased regulations to allow patients to access the drug by mail during the pandemic. Now, the FDA has made that change permanent.
While mifepristone specifically has faced tough restrictions in the past, it’s mifepristone and misoprostal together that reliably induce abortion. Mifepristone on its own only results in abortion about 50% of the time, according to Lauren MacAfee, a gynecologist and obstetrician who provides abortions at University of Vermont Medical Center.
Mifepristone softens the cervix and blocks the production of progesterone, a hormone that is important in maintaining a viable pregnancy. Next, misoprostol causes uterine contractions, which results in the pregnancy tissue being expelled. This is the same mechanism by which doctors manage early-term miscarriages. In the past, stringent regulations on mifapristone have reduced miscarriage patients’ access to the drug, and sometimes they were left only with misoprostal, which is not as quick or effective as the drugs are when combined.
“Miscarriage and abortion are identical in many ways, and if we’re playing on the guise of safety, one is stringently regulated and one isn’t, but if it’s really about safety, it should be equal,” MacAfee said.
Some states with especially restrictive abortion laws already are fighting back to decrease accessibility within their borders. Nineteen states have banned telemedicine visits for mediation abortions, so the FDA’s new ruling will not have an impact. Vermont is not among them.
MacAfee said expanded access to the medication will be beneficial for Vermonters.
“People who live in rural communities and don’t have access to a local clinic, people who are night shift workers and struggle to get into clinics during normal business hours, moms who can’t get away from child care to go to the clinic,” MacAfee said, “there are so many different people who might struggle with access in Vermont.”
While the pill can be accessible remotely — that means no in-person doctor’s visit required — a doctor still needs to be licensed in Vermont to prescribe the medication. And not every clinic in Vermont can offer remote access to mifepristone. In fact, a more common way for Vermonters to access the medication remotely likely could be through a larger national organization offering medication abortions through the mail, such as carafem.
Carafem is a relatively new, prescription-only abortion clinic offering medication to induce abortion for pregnancies up to 11 weeks by mail in 10 states — including Vermont — and the Dictrict of Columbia. Patients meet by video with a provider and could be prescribed mifepristone and misoprostol to terminate their pregnancy at home. The provider gives them information about what to expect and instructions on how and when to take the pills.
MacAfee said the incidence of complications from early-term medication abortions at home is less than 4%, and typically these drugs are very safe.
However, Rep. Vicki Strong, R-Caledonia, has expressed concerns. Strong supports parental consent for abortion and wants to be sure that young girls who seek an abortion would include their parents in that decision, even if they were accessing abortion drugs remotely. However, state law in Vermont does not require that parents be informed of their child’s abortion, and that will hold true for abortions accessed remotely.
“I personally don’t think this is the right way to go forward. I’m worried about the long-term effects and the emotional and physical well-being of young women who do this at home,” Strong said.
Strong said she is concerned that women seeking abortion would not recieve adequate support or counseling if their treatment is accessed exclusively online. Strong said she believes the state Legislature should consider restricting access to the pill by mail.
“I’m very much more in favor of more regulation, not less, when it comes to protecting women,” she said. However, she admits she thinks it is unlikely the legislature will take this on.
Sen. Ruth Hardy, D-Addison echoed Strong’s claim that the state legislature is unlikely to take issue with this. Hardy said she cannot imagine a scenario in which the Vermont Legislature stands in the way of remote access to abortion medication. However, Hardy said that because Vermont already has few restrictions in place around abortion access and ample clinics throughout the state, she does not see abortion by mail as being a huge deal for Vermont. But she said she is always glad to see access expand.
“I’m happy that there are now fewer restrictions and greater access to reproductive health care,” Hardy said.
