Unpacking the FDA’s Medication Abortion Changes with Just the Pill
Last December, the U.S. Food and Drug Administration (FDA) announced they would be modifying their shared Risk Evaluation and Mitigation Strategy (REMS) around the dispensing of medication abortion.
This change removes the requirement that Mifespristone (the first medication in a two-medication abortion process) be dispensed only in certain health settings such as clinics or hospitals, and also adds that pharmacies dispensing the medication must be certified.
Reproductive health, rights, and justice advocates, including UnRestrict Minnesota, applaud this change given what it might mean for abortion access in a time of unprecedented abortion restrictions rolling through conservative states and a new Supreme Court poised to decimate the already tenuous protections afforded by Roe v. Wade.
We weren’t sure what to make of this change, so we asked our UnRestrict partners and local abortion pill experts Just the Pill about what this new FDA update means for our communities.
While this announcement is promising, the actual rules around implementation have yet to be written, leaving quite a bit unanswered.
Specifically, it is unclear what government agency will be in charge of writing and enforcing these changes, whether that be the FDA, CDC, or otherwise.
In order for people seeking abortions to realize the benefits of this expansion, pharmacies and pharmacists will need more clarity around what type of certification will be required and how they can become certified and able to dispense Mife.
“People don’t know that they can’t just show up to the pharmacy and pick up Mife[pristone].”
Currently, people can get their medication abortion in one of two typical ways: in-clinic or via telemedicine/mail order.
In-clinic appointments are exactly that. The patient schedules an in-person appointment to take the first (Mifepristone) of two medications needed. Depending on the state you live in (or the state your appointment is in) the patient may need an additional in-person or telephone appointment at least 24 hours prior.
Telemedicine or telehealth appointments allow patients the ability to talk with their doctors virtually. Depending on the state you live in, this could mean an appointment from the comfort of your home or visiting one of Just the Pill’s mobile clinics.
Up to now, Just the Pill has been able to utilize certain supportive mail order pharmacies to deliver the abortion pills.
“We’re hoping this will change once pharmacies can get instruction. Then people will be able to pick up pills at their local pharmacy,” said Dr. Julie Amaon, MD. and Executive Director of Just the Pill. “We’re still not clear yet if this means that pharmacists will need special training to get the ability to dispense.”
This of course will still be dependent on the pharmacy, as rural women and people who can get pregnant experience pushback even now from pharmacists in their area who deny service for emergency contraception and even birth control pills.
“Roe is just a skeleton, anyway.”
This announcement from the FDA arrives within a national context in which 21 states have laws on the books that could be used to restrict abortion, including unenforced pre-Roe bans (8), post-Roe trigger bans (12), and additional restrictions.
The REMS change won’t change things for people who live in the 19 states with bans on telemedicine services. For example, folks in the Dakotas would still need to travel to Minnesota, Montana, or Wyoming for care.
The FDA is also a federal organization and it is still unclear as to how their ruling would work with statewide bans now and especially after (what abortion experts are anticipating will be) a devastating ruling by the Supreme Court this spring that will further gut – if not fully remove – the protections of Roe.
“The FDA is the floor, and states are the ceiling. States will still be able to restrict access, and with the likely falling of Roe, that will be accompanied by a national wave of trigger bans on abortion coming into affect,” Dr. Amaon has had patients say:
“I never knew it was going to be this hard until I needed an abortion.”
Now is the Time to Expand Access Where We Can
One thing we do know is there shouldn’t be so many hoops that people have to jump through just to receive general health care.
“We have been exploring all the ways it looks like to expand care. Right now, Just the Pill is providing abortion via telemedicine in Minnesota, Montana, and Wyoming. We’re currently raising funds for a fleet of mobile clinics in the Midwest by the end of summer to handle the major influx of people traveling from out of state. And through Abortion Delivered, we are expanding to southern states with mobile clinics offering expanded services including “procedural” abortions and IUD insertions.”
Here in Minnesota our State Constution protects the right to abortion. But that hasn’t stopped decades of restrictions and red tape from building up and making it difficult to access and even provide care.
“We need people to continue to tell their legislators that we need more proactive laws. Remove the 24-hour waiting period, remove the terrible state-mandated script. These are still barriers for people. If we are going to have an influx of people traveling here – and if [Minnesota is] going to be a ‘safe state’ – we’re going to need to take down all the restrictions possible to make accessing care as easy as possible.”
Support UnRestrict Minnesota’s Community Partners
UnRestrict Minnesota is a community supported, public awareness campaign that aims to educate and motivate Minnesotans to stay informed about the abortion laws in our state. The campaign is driven by the critical work of UnRestrict Minnesota’s partner organizations including the LGBTQ advocates, faith communities, doctors, activists, abortion funds, lawyers, organizers, clinics, doulas, podcasts, and many others that make up the UnRestrict Minnesota coalition.
UnRestrict Minnesota Community Partners are recruiting volunteers! Learn more below about how you can support their work. Check back on a monthly basis for new opportunities.
More information about Medication Abortion:
Just the Pill – https://www.justthepill.com/
Plan C Pills – https://www.plancpills.org/