Is Massachusetts ready for abortion through the mail?
Reproductive rights advocates certainly are. They note that medication abortions — safe and FDA-approved in the first 10 weeks of gestation — already make up 40 percent of abortions in Massachusetts. People have been ending pregnancies at home, on their own, for years.
But the Food and Drug Administration requires a patient to pick up the medication in person from a health provider — a requirement the Trump administration upheld even during the pandemic. During last year’s lockdown, the American College of Obstetricians and Gynecologists sued and got the requirement lifted temporarily in July. But the Trump administration appealed, and the Supreme Court reversed that decision in January.
Now, the in-person requirement is being waived for the first time in Massachusetts as part of a “TelAbortion” study in which patients get the medication by mail. Gynuity Health Project is running the study in 17 states and Washington, D.C.
Reproductive rights advocates hope that broader documentation and acceptance of that method will lead to increased access for patients who live far from abortion clinics and will persuade the FDA to lift the requirement for in-person dispensation.
Dr. Tara Shochet, Gynuity’s senior program director, said the study was launched to gather evidence and demonstrate that “you can provide pills outside of the office setting, and it’s still a very, very safe and effective situation.”
Abortion opponents, however, challenge the safety of telabortion, as well as the wisdom of handling such a sensitive process remotely. Massachusetts Citizens for Life executive director Patricia Stewart said in a statement that virtual medical screenings, more common during the COVID-19 pandemic, are not optimal.
“Women in the TelAbortion study, who are attempting to conceal their abortion, may already feel isolated. The lack of human connection and TelAbortion’s virtual contact only with a physician can worsen the sense of isolation,” Stewart said. “The impersonal TelAbortion system fails women in their care, when they most need help and a human touch.”
Medication abortions were approved by the FDA in 2000, but activists began clamoring for a telehealth option when the pandemic heightened the urgency of patients who faced a ticking clock amid lockdown orders.
Some states bar telehealth for abortion, however. And if the 1973 Roe v. Wade ruling that guaranteed abortion rights is overturned, as many expect under today’s conservative Supreme Court, states could make medication abortions illegal. (Massachusetts recently enacted a law affirming the right to abortion.)
The study is not entirely virtual. Under the terms approved by the FDA, a participating patient must still visit a local health care provider before the abortion to confirm the gestational age of the pregnancy through an ultrasound or a pelvic exam. However, Shochet noted that the ultrasound can be done by any doctor or lab, not necessarily an abortion provider, potentially lessening travel for a patient who lives far from a clinic.
“There’s the ease of being able to do that locally,” she said.
Afterward, a patient seeking an abortion through the study will confer with a specialist by video and get pills delivered discreetly by mail. Maine Family Planning, the leading provider of reproductive care in that state, is working with study patients in Massachusetts, as well as New York.
A medication abortion, approved only in the first 10 weeks of pregnancy, requires taking a dose of mifepristone, followed 24 to 48 hours later by a dose of misoprostol.
Providers say patients sometimes experience heavier bleeding and stronger cramping than a period. But even if administered later in pregnancy, the medication does not produce serious adverse outcomes; it fails to end the pregnancy, said Leah Coplon of Maine Family Planning.
“What we see generally is, if they’re further along, it just doesn’t work,” Coplon said.
In response to safety concerns, providers note that the lengthy process of a medication abortion is never overseen in a clinic.
“Regardless of whether you get your medication in the clinic handed to you, or in the mail, the whole process occurs outside of the clinic setting,” Shochet said. “Women have been passing pregnancies at home since the beginning.”
Medication abortions were approved two decades ago but are still tightly controlled, said Rebecca Hart Holder, executive director of NARAL Pro-Choice Massachusetts.
“The fact that the FDA forces patients and providers to jump through the same hoops as when medication abortion care was first approved 20 years ago is shameful,” she said. “This unnecessary barrier is further proof of how the political process has been used to push abortion care out of reach.”
Representative Ayanna Pressley, who has been pushing the FDA to permanently undo the requirement that medication be dispensed in person, called the restrictions imposed by the Trump administration during a pandemic “cruel and unnecessary.”
“Against the backdrop of an ongoing pandemic that makes in-person appointments potentially dangerous for patients, and in the context of systemic efforts to deny abortion care — particularly to Black and brown people — efforts to expand, not limit, access to abortion medications by mail are a critical component of the fight to ensure access for all,” Pressley said in a statement.