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Almost half of all early abortions are done with the simple action of taking a few pills. The pills are safe to take at home, with very low rates of complications. So why can’t you get them through an online doctor’s service, like we can with birth control pills and other medication?

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Part of the reason is a federal law that prevents mifepristone, one of the necessary pills, from being dispensed like other prescription drugs. The only way to get it is to visit a health care provider who has registered with the FDA under a special program. The ACLU is now suing the federal government to lift this rule, because it doesn’t benefit patients in any way.

The rule “maybe made sense back in 2000 when the drug was first approved with very little safety data in the US,” says Dr. Daniel Grossman, a professor of obstetrics and gynecology at the University of California at San Francisco and the director of ANSIRH. He has argued that restrictions on mifepristone just make it harder for pregnant people to get an abortion early in pregnancy, and lead them to later abortions that are both more expensive and difficult, and riskier (although no abortion is more dangerous than childbirth).

So how do the regulations make the drug difficult to get? A doctor who might only prescribe it to a few patients a year isn’t going to bother stocking the drug, Dr. Grossman says, and might not want to register for fear of being labeled as an abortion provider and targeted by anti-abortion activists. The drug was supposed to solve the problem of abortion availability, but restrictions by the FDA and by states have meant the problem is still very real.

State Laws Make It Hard to Take a Pill

Besides federal laws, each state has their own abortion laws that can affect the availability of medication abortion. Kaiser Family Foundation has a breakdown of those laws here.

In some states, mifepristone is regulated in ways that no other pill is. For example, in three states, the drug has to be prescribed exactly as its labeling instructs. That might not sound so bad, but it stops prescribers from using the medication in a better way than what was fossilized on the labeling—for example, if new research shows that a different dosage is safer or more effective. For any other drug, providers can prescribe “off label” according to their clinical judgment.

And in fact, in 2016 the FDA label for mifepristone was updated to include major changes that reflected how doctors already knew the drug could be prescribed: for a longer period of pregnancy, at a lower dose, and without in-person physician supervision. Doctors in several states were already using the drug this way, but in other states they had been forced to use the outdated rules.

Some states allow telemedicine—essentially, a very official Skype call—as long as you’re sitting in a clinic. This helps to make the drug more accessible, but many states don’t even allow this. The laws involved typically say they are for safety’s sake.

So Dr. Grossman called their bluff, and conducted a study to compare telemedicine and in-person medication abortions. The study found that adverse effects were extremely rare: 0.18 percent of telemedicine patients, and 0.32 percent of in-person patients. (None were deaths or were severe enough to require surgery.) The American Congress of Obstetricians and Gynecologists endorses telemedicine for medication abortions, writing that they “can be provided safely and effectively via telemedicine with a high level of patient satisfaction.”

Bringing It Home

But this all refers to telemedicine in a clinic. I asked Dr. Grossman if it would make sense for abortion pills to be delivered through an online service, like many other drugs are. (He had already noted that abortion pills’ side effects are much safer than those of other prescription drugs, including Viagra.)

“I do think that that’s reasonable,” he says. “These drugs are very safe.”

The person who orders the pills would have to be very sure of how far along they are in the pregnancy, he points out, since the typical regimen of mifepristone and misoprostol is only for pregnancies that are 10 weeks or less. (A variation with larger dosages may be appropriate for some later-term pregnancies, but you would want to talk to a doctor about whether that’s your best option.)

Services like Women on Web help people in some countries to obtain abortion pills over the Internet, but currently none will ship pills to the US; they focus on countries where abortions are even harder to obtain.

But if you can get the instructions, and obtain the pills, you could, theoretically, induce your own abortion at home. We are absolutely not recommending that you do this. But if you’re curious about how it works, abortionpillinfo.org has the information.

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If you google “abortion pills” looking for something to buy, you’ll find all kinds of different products on offer, from herbal cleanses (don’t use these) to emergency contraception (if you’re already pregnant, it’s too late). But then there are sketchy pharmacies out there that will sell what they say are genuine mifepristone and misoprostol.

A new study in Contraception, authored by the team behind the Plan C project that provides information on medication abortion, shows what happens when you order these pills. They sent samples to a lab, and found that all of the mifepristone pills contained mifepristone in the correct dosage. Some of the misoprostol pills had a lower dosage than what was on the label, possibly because of incorrect storage.

Prices ranged from $110 to $360, including shipping (the average price for a medication abortion at a clinic is around $500), and took anywhere from three to 21 days to be delivered. “Nearly all of the pills we ordered arrived,” the authors write. Not exactly reassuring. They published a list of who sent them what, and for how much, although there’s no way to guarantee what you would get if you placed an order tomorrow.

Since these drugs are safe to take at home, and a faraway prescriber can effectively manage your care, there’s no reason somebody should have to drive hundreds of miles to an abortion provider just to get them. It’s time for the laws about abortion pills to catch up with the science.