Self-Managed Early Abortion Care Is Now Accessible Online in the US

A new online service, Aid Access, offers women an option to buy early abortion pills online and receive both medical consultation and physician-supported medical care at a critical time for reproductive health.

Abortion care advocates say Aid Access’ services — which are now available in the United States after being available for a decade in other countries — normalizes self-managed care and provides a safe, confidential, medically-supported alternative to clinic-based care for early abortion.

Elisa S. Wells, co-director of the medication abortion advocacy group Plan C, told Rewire.News that from the organization’s perspective, “Aid Access’ medically-supported and affordable model of early abortion care is helping to address severe access restrictions in the United States while also responding to what we know those seeking abortion care want — convenience, confidentiality, and control.”

Plan C recently released a report card scoring Aid Access favorably on price, quality, and physician oversight.

The site has helped around 600 women access abortion pills in the United States in the few months since it was launched, said Dutch physician Dr. Rebecca Gomperts, who founded Aid Access and helped more than 75,000 women access pills around the world via the Women on Waves and Women on Web websites. The response has been overwhelming, she told Rewire.News. They include heartfelt notes from a woman with three disabled children who “cannot financially or emotionally support one more child”; a woman who was drugged, raped, and struggling to raise one child; and another who does not have a vehicle or a driver’s license to get to the nearest abortion clinic three hours away.

At a time when women and providers are being criminalized for abortions and reproductive rights are under attack by a president who promised to reverse Roe v. Wade, this is an option that has already been lifesaving for many, as emails shared by Gomperts show. “Had I not had this resource, I would have had no other choice than to take extremely dangerous actions to get this same result. This kind of care is not accessible where I live, with the closest women’s center over 80 miles away,” reads one of the responses.

Wells also noted the critical timing of the launch of Aid Access’ site. “At a time when those who value reproductive autonomy and choice are feeling disheartened by recent political events — in particular, the appointment of Brett Kavanaugh to the Supreme Court and the further erosion of abortion access that is likely to ensue, this service creates new opportunities for those seeking early abortion to counter the over-regulation and over-medicalization of abortion care in the United States and take control of their own health,” she said.

Aid Access, which aims to serve pregnant women at less than 10 weeks’ gestation, prescribes mifepristone and misoprostol pills, both U.S. Food and Drug Administration (FDA) and World Health Organization-approved medications available through clinics. It bypasses barriers like high costs, mandatory waiting periods, parental consent for minors, and provides an easy option to access abortion care, the site’s homepage states.

The service costs about $95 with a sliding fee scale available for those who can’t afford it and includes support through phone and email throughout the abortion process. The pill is then purchased through a pharmacy and mailed to the patient with detailed instructions.

To place an order, people submit basic medical information, including the date of their last period, a shipping address, and a secure online payment method. Orders usually arrive within ten days in discreet plain packaging.

After 15 years of use in the United States, it is a fact that medication abortion is “extremely safe and effective,” said Dr. Daniel Grossman, professor at the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, and director of Advancing New Standards in Reproductive Health. “When it comes to self-managing an abortion, research shows that when people have accurate information and access to high-quality medication, they can use the abortion pill safely and effectively on their own,” he said in a statement.

Self-managed abortion is not new but is vilified by right-wing and religious groups opposed to abortion rights as akin to the dangerous back-alley options used before abortion was legalized in 1973. That could not be further from the truth, Megan K. Donovan, senior policy manager with the Guttmacher Institute, explained in a recent policy review.

“This framing is flawed for several reasons,” wrote Donovan.“First, it overlooks the reality that abortion access is already limited for many women, as well as for transgender men and gender-nonconforming people, because of restrictive policies in many states and the lack of abortion clinics in wide swaths of the country. Second, it ignores the existence of safe and effective models for self-managed abortion care. And, third, it fails to account for the possibility that some people, such as those who have reason to distrust the medical system, may opt to self-manage abortion for reasons other than lack of access to a clinic, such as increased privacy and autonomy.”

Guttmacher Institute reports indicate that in 2014, medication abortions accounted for 31 percent of all nonhospital abortions, and for 45 percent of abortions before nine weeks’ gestation.

Options like Aid Access are all the more critical in today’s political climate, where women and doctors are being criminalized for seeking and providing abortion services, suggested advocates.

“With a decidedly anti-abortion majority now on the Supreme Court, we are likely to see clinical abortion even more restricted or pushed out of reach entirely. It’s not surprising to see new efforts to distribute a safe, effective abortion option. Though abortion is legal, people who end their own pregnancies, and those who assist them, may be reported, arrested, or imprisoned. We should ensure that however a person decides to end a pregnancy, they can do so safely, effectively, and with dignity,” Jill Adams, chief strategist at the SIA Legal Team, which works to destigmatize non-clinical abortion in the United States, said in a statement.