A surge in abortion pills abroad has softened the effects of state abortion bans
But the number also somewhat understates the number of abortions. It does not include people who ordered pills from other overseas websites. Aid Access is the largest such provider, but there are others recently launched or expanded. The data also excludes women who had abortions outside the formal health system by other means, such as bringing in herbs or crossing the border into Mexico to obtain an abortion pill sold over the counter as an ulcer medicine. These abortions are often secret and difficult to measure.
“There are a large number of people who self-manage their own abortions, absolutely,” said Renee Bracey Sherman, activist and founder of We Testify, a group that shares abortion stories, including those of people who have self-managed their own abortions. “Because people get them in their communities and because they get them in a lot of different ways.”
Abortion pills are a combination of the two drugs mifepristone and misoprostol that stops the development of the fetus and then causes a miscarriage. The process takes several days. A small proportion of women who take them do not experience a complete abortion, and they need follow-up care in the hospital.
The drugs are approved by the Food and Drug Administration and are offered by abortion providers in states where abortion is still legal. In recent years, more women chose medical abortion over clinical procedures. In December, the FDA approved the prescription of the abortion pill telemedicinehowever, without the need for a physical visit to an abortion clinic many states prohibit it.
Bypassing US laws, Aid Access connects patients with European doctors and then ships pills from Indian pharmacies to patients in the United States.
It is illegal to sell prescription drugs to Americans without a prescription from a physician licensed in the United States. Between 2000 and 2020, there were at least 61 cases in which people were criminally investigated or charged with having administered their own abortions or helped someone else do so, according to If/When/How, a legal group that supports reproductive rights.
And after the Dobbs decision, some states tightened laws regarding medical abortion. However, they are difficult to enforce because the pills come by mail and overseas pharmacies are usually beyond the jurisdiction of local law enforcement.
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