Access to abortion care has narrowed dramatically in the US. But there’s been one big shift in the other direction: the ability to access care without leaving home. In 2021, during the pandemic, the US Food and Drug Administration temporarily allowed health-care providers to mail patients two pills—mifepristone and misoprostol—that, when taken together, can induce an abortion. Years before, the FDA had found the pills to be safe and effective at ending a pregnancy in the first trimester, and by 2020 they accounted for more than half of all abortions in the US. Then, at the end of 2021, the FDA made its decision permanent.
Six months later, the US Supreme Court ruled that abortion is not a constitutional right. As state “trigger laws” prohibiting abortion took effect, interest in and demand for abortion pills surged. Nonprofits like Aid Access and startups like Choix, Just the Pill, and Hey Jane were ready to help. Though the process varies by service, eligible patients generally sign up with a photo ID and then consult with a medical provider via video call, text, or app. The provider prescribes the pills, which the service ships to the patient.
Access to medication abortion is not a solved problem. Aid Access, with headquarters in Europe, is unique in that it will ship pills to any US state. But most startups offering abortion pills by mail follow state laws, which means people living in the 13 states that ban abortion, or in the additional seven states that require a doctor to prescribe the medications in person, must travel across state lines or set up an alternative mailing address to use these services.
Still, the organizations helping people obtain abortion pills remotely have brought care to many at a critical time. Their foresight and tireless efforts meant these solutions were ready when people needed them.
Update: In January 2023, the FDA said it would permit online and brick-and-mortar retail pharmacies to dispense abortion pills to patients who have a prescription, in a step that could further expand access to these medications in states that allow it.
