If the Supreme Court strikes down Roe v. Wade, as a leaked draft opinion suggests it will, about half the states are expected to ban abortion immediately. That will leave many women desperate for a workaround. And “medication abortion” will be their best option.
Decades of research show the two-drug combination of mifepristone, which blocks a hormone crucial to the progress of a pregnancy, and misoprostol, which causes contractions and empties the uterus, is safe and effective. And it already accounts for more than half of American abortions.
But accessing the pills in a post-Roe world will be tricky. Women in states that bar abortion will have to go through international nonprofits like Aid Access, which the Food and Drug Administration has attempted to shut down. Or they’ll have to drive across state lines, pull over to the side of the road to dial into a telemedicine appointment with a physician, get approved, book a motel, and wait for pills to arrive by mail.
That’s a pricey and onerous process, especially for low-income women. And delayed access to the pills can present real problems: Women are only eligible to take them in the first 10 weeks of their pregnancies.
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But there is a way to improve access: Make the pills available for over-the-counter sale. That way, women in antiabortion states could ask friends or family members in neighboring states to visit a pharmacy or grocery store, grab the two-drug combination off the shelf, and send it along. Or, if time was a concern, they could drive across state lines themselves and make a quick purchase.
Women in states that keep abortion legal would benefit, too, from over-the-counter sale. The pills, on their own, cost as little as $60. But getting a medication abortion through a clinic costs about $500 on average.
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The FDA would have to approve the switch from prescription to over-the-counter sale. And no one expects that anytime soon. The regulatory process is rigorous. And abortion politics are fraught.
But the case for over-the-counter sale is already quite strong. Not only is medication abortion safe and effective, but there is also mounting evidence that tight restrictions on dispersal of the pills aren’t necessary.
Before the pandemic, women had to meet with a physician in person before getting the pills — and they typically had an ultrasound and pelvic exam. But research shows that even after the FDA temporarily relaxed its rules and allowed telemedicine visits because of COVID-19, the safety and efficacy of the pills remained high. And in December, the agency moved to permanently lift the requirement for in-person visits.
Cutting out the doctor altogether is something else. But early research led by the Advancing New Standards in Reproductive Health group at the University of California, San Francisco, suggests that wouldn’t be a problem.
One critical question for the FDA would be how well equipped women are to measure the length of their own pregnancies — and determine whether they meet the 10-week threshold for taking the pills. A study published in December by researchers at Advancing New Standards and several other organizations shows that women seeking abortions at seven clinics across the country were highly successful at gauging the length of their own pregnancies. A separate study, published last week, tested a mock over-the-counter label for abortion pills and found a high degree of comprehension.
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Daniel Grossman, a professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, who directs Advancing New Standards, says more research aligned with FDA standards is in the works. “The reason we’re doing this research is to demonstrate proof of concept — that these medications are actually appropriate for [over-the-counter] sale,” Grossman said.
It would be up to the company that sells mifepristone in the United States, Danco Laboratories, to initiate the formal process with the FDA, though. And a spokeswoman for Danco told the Globe editorial board the company has no plans, at present, to pursue over-the-counter sale. She left the door open for a future application, though, saying the research out of Advancing New Standards represents an important start.
And starts are important. As the shock over the leaked Supreme Court draft begins to wear off and the reality of the new, long-slog fight over abortion access sinks in, it’s clear that emergency support for American women who lose the right to choose will not be enough. Ambitious, long-term plans for expanding access will be vital too.
Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.
