A group in Europe that prescribes abortion pills to people in the U.S. online said it has seen a surge in requests since a federal judge in Texas issued a decision imperiling future access to mifepristone.
"We have seen an enormous ... increase in requests since the ruling in Texas," said Dr. Rebecca Gomperts, a Dutch physician who runs the service called Aid Access. "People are extremely anxious."
She said she could not yet quantify the precise size of the surge but added that it "has been a steep increase."
The Supreme Court has blocked the decision from U.S. District Judge Matthew Kacsmaryk from taking effect until at least Friday night.
Kacsmaryk ruled April 7 that the Food and Drug Administration's approval of mifepristone — one of the two pills in the standard regimen for a medication abortion — would be paused while a case challenging it plays out. An appeals court subsequently blocked part of the judge's decision but said changes the FDA made to the drug’s approved use since 2016 could be temporarily reversed.
The government then appealed that decision to the Supreme Court.
The legal fight has created considerable uncertainty about the future of access to mifepristone.
Abigail Aiken, an associate professor of public policy at the University of Texas, Austin, has been tracking requests for self-managed medication abortion. She said a recent increase in inquiries to Aid Access would be “in line with what I would expect, given the confusion the decision and the ensuing back-and-forth legal process is likely to cause to people seeking abortion care.”
“We saw a similar sharp spike in requests at the time the Dobbs decision was leaked, about a month before the decision was formally announced,” she said, referring to the Supreme Court ruling that overturned Roe v. Wade. “Even though there hadn’t been any changes to state abortion laws at the time of the leak, there was still a rapid increase in requests to the Aid Access service.”
Aid Access doesn't plan to back down
Gomperts founded Aid Access in 2018. Those who visit the organization's website can answer a series of questions, and a medical team reviews the responses and can write prescriptions. The prescriptions then get sent to pharmacies outside the U.S., and the pills are shipped by mail to patients.
The FDA said it “does not recommend” ordering mifepristone online, and has sent warning letters to websites “selling unapproved and misbranded mifepristone and misoprostol over the internet, including AidAccess.”
That has not stopped Gomperts. In March 2019, the FDA, under then-President Donald Trump, sent a warning letter asking the organization to cease operations. Aid Access refused.
“For me, it’s really, fundamentally, about social justice. It’s a very urgent medical need that people have,” Gomperts said of abortion pills. Denying access is "very discriminatory," she added, since such bans affect women, transgender people and those with limited financial resources.
The FDA did not immediately respond to a request for comment about the agency's current stance on Aid Access’ work.
Aiken published research last year showing that average daily requests to Aid Access for abortion medication increased by 160% following the Supreme Court’s Dobbs decision. Whereas the group got an average of 83 requests per day in the period from September 2021 through April 2022, the number jumped to 214 between June 24 and Aug. 31, 2022.
The upward trend has continued, with an average of 254 requests per day between September 2022 and January, Aiken added.
"That’s a 206% increase over baseline," she said.
Abortion pills are approved in more than 80 countries
Access to medication abortion is currently legal in some form in 37 U.S. states. The regimen involves taking mifepristone followed by another drug, misoprostol. It is the most common way to terminate an early pregnancy, according to the Guttmacher Institute, a research group advocating for abortion rights.
Mifepristone is widely used around the world and approved in more than 80 other countries, according to the FDA.
The FDA maintains that medication abortion is safe and says periodic reviews of data on mifepristone's use "have not identified any new safety concerns." Research has shown that the two-pill regimen has a 0.4% risk of major complications.
The plaintiffs in the lawsuit challenging mifepristone, however, allege that the drug is unsafe, and Kacsmaryk agreed with them in his decision — a stance Gomperts called "outrageous."
“It’s definitely safer than giving birth, so the arguments that are being used are so outrageous, anti-scientific, it scares me," she said. "It really scares me that this is possible that there’s a group of people who are able to determine the lives of other people based on bulls---."
