In a delayed but important win for reproductive rights, the Food and Drug Administration announced on Monday that Americans can now receive abortion pills via mail for the remainder of the COVID-19 pandemic. The FDA's acting commissioner, Janet Woodcock, MD, wrote that the Center for Drug Evaluation and Research found no "increases in serious safety concerns" for individuals taking mifepristone, one of two pills needed for a medication abortion, from their own home.
This decision comes after a near-year-long battle spanning the FDA and the Supreme Court. Last May, the American Civil Liberties Union filed a lawsuit challenging the FDA's previous restrictions on abortion pills: The organization wrote that forcing patients to travel to hospitals, clinics, or other medical centers in order to pick up mifepristone poses life-threatening risks and unnecessary exposure to COVID-19.
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But Mifepristone was first approved by the FDA in 2000 and has proven to be safe and effective. And, according to a 2017 study in Obstetrics & Gynecology, there was essentially no significant difference in adverse effects between people who received the pill in person and people who received it through telemedicine. Anti-abortion activists argue that the pill should be taken with medical oversight, ignoring the fact that the FDA already allows people to take mifepristone from home — they just have to pick it up in person. Ultimately, there's no scientific or medical reason that mifepristone shouldn't be as readily available as any other prescription.
"The FDA requires patients to travel to a hospital, clinic, or medical office to pick up the mifepristone," wrote the ACLU, on behalf of medical experts from the American College of Obstetricians and Gynecologists. "Because of this restriction, patients who have already been evaluated by a clinician (using telehealth or at a prior in-person visit) cannot fill their mifepristone prescription by mail."
A federal district court ruled in favor of the ACLU in July 2020, but in January — at the request of the Trump administration — the Supreme Court essentially reversed the decision. In her dissent, Justice Sonia Sotomayor argued that reinstating the FDA's in-person requirements "imposes an unnecessary, irrational, and unjustifiable undue burden" on people exercising their right to an abortion during a dangerous public health crisis.
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The pandemic has only exacerbated a long-existing problem. Abortion access in America has become more and more limited, with certain states requiring parental consent or mandated counseling, barring private insurance plans from covering abortion, and implementing gestational limits. But access — in the most literal sense — is still one of the biggest barriers patients face. According to a 2019 study from the Guttmacher Institute, nearly one out of five patients travel over 50 miles to receive an abortion, usually because there are no nearby clinics. In 25 states, individuals have to wait around 24 hours between a pre-procedure counseling session and the procedure itself, which forces many to take two separate trips.
These restrictions harm people in rural areas and people unable to travel, sometimes out of state, to get a safe procedure. In the wake of the pandemic, these restrictions also impact people living in the places hardest hit by COVID, and those in newly precarious financial situations. And, as noted by Monica Simpson, the executive director of SisterSong Women of Color Reproductive Justice Collective, people of color are also disproportionately impacted.
"Black and Brown people are more likely to have preexisting health conditions that increase the likelihood of severe illness and death from COVID-19," Simpson wrote in a statement. "It is unconscionable that the FDA is subjecting women of color, who are disproportionately represented among patients seeking abortion and miscarriage care, to life-threatening viral risks as a condition of obtaining these urgent reproductive health services."
Ilyse Hogue, president of NARAL Pro-Choice America, praised the FDA under the Biden administration for making this decision. "Trump allowed most prescriptions to go through the mail during the pandemic, even highly addictive ones, but kept the medication rule in place. Not for science, for punishment," Hogue wrote on Twitter. "Biden's FDA lifting this rule will have material impact, ease stress and create more access for those who need abortion. It's a big deal."
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