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An FDA decision gives more access to abortion pills by mail, but state laws differ


The growing number of patients seeking to end pregnancies are using abortion pills. And in an increasingly restrictive climate for abortion providers, many are taking those pills at home. And as NPR's Sarah McCammon reports, activists on both sides of the issue are taking note.

SARAH MCCAMMON, BYLINE: Earlier this year, Ilana Engel had what she calls a birth control mishap and found out she was pregnant.

ILANA ENGEL: And my husband was like, whatever you want to do. If you want to bring the baby to term, that's fine. If you - we'll figure it out. But if, like - if you don't want to, like, it's your decision, whatever you want to do.

MCCAMMON: Engel is 33 and not sure if she wants kids. After some research, she decided on a medication abortion using a drug called mifepristone, followed by a second drug. Engel made sure she knew where to go for emergency care if she needed it and set herself up in front of her TV with a heating pad to help with the cramping she experienced for several days.

ENGEL: I took it on a Friday night. And it was rough, but I don't regret it.

MCCAMMON: In New York, where Engel lives, abortion pills are available through telemedicine with a doctor's help. But Engel chose to get the pills online through a European-based organization called Aid Access. She filled out a questionnaire about her medical history, and within a few days, she says the pills arrived by mail to her home in Brooklyn.

ENGEL: I just liked the ability to do it in the comfort of my own home and to have someone, like, around that would be able to support me if I, like, needed help.

MCCAMMON: On Thursday, the Food and Drug Administration took a step toward easing access to abortion pills. Until recently, doctors who prescribed mifepristone had to dispense it to patients in person. That rule was suspended because of the pandemic, allowing doctors to prescribe pills through telehealth and mail them to patients. And now the Biden administration has made that rule change permanent. But many states have their own restrictions. Nineteen still require the pills to be prescribed in person. So some women are finding other ways to get them.

Elisa Wells is co-founder of the nonprofit group Plan C, which provides information about where to get abortion pills. She says after a Texas law took effect on September 1 banning most abortions in that state, she heard from many women there.

ELISA WELLS: On September 2, I think our traffic to our website was 25,000 people, most of those from Texas. And that's in comparison to prior to SB8 going into effect when we were having, you know, fewer than a thousand a day.

MCCAMMON: Groups opposed to abortion rights warned that taking pills at home could put patients at risk. But the World Health Organization says it can be safe under the right conditions. And several U.S. medical groups agree. Use of the abortion pill has become so widespread that it now accounts for about 4 in 10 abortions in the U.S.

Marjorie Dannenfelser is with the Susan B. Anthony List, which opposes abortion rights. She says even as her movement wins victories in state capitals and the courts, medication abortion is shifting the battle lines.

MARJORIE DANNENFELSER: That change means that we're less engaged in the public arena because it's secret. It's behind closed doors.

MCCAMMON: She's pushing for new state restrictions on the pills.

DANNENFELSER: That is why we're working so closely together to do this on the state level in every single place we can.

MCCAMMON: A new Texas law took effect this month prohibiting the delivery of abortion pills by mail. But Elisa Wells of Plan C says that does little to stop health care providers outside Texas.

WELLS: These pills are coming in from overseas, or they're being mailed by people from within the United States. But there's not really a mechanism for policing that.

MCCAMMON: Wells says if the Supreme Court overturns Roe v. Wade, more abortions may move from clinics to homes, prompting even more battles over abortion pills. Sarah McCammon, NPR News. Transcript provided by NPR, Copyright NPR.

Sarah McCammon
Sarah McCammon is a National Correspondent covering the Mid-Atlantic and Southeast for NPR. Her work focuses on political, social and cultural divides in America, including abortion and reproductive rights, and the intersections of politics and religion. She's also a frequent guest host for NPR news magazines, podcasts and special coverage.