An online clinic offers abortion pills to patients who are not pregnant in Illinois and several other states, keeping the drug on hand for future use.
Choice, a California-based reproductive healthcare startup, launched the service on Wednesday to increase abortion access, particularly after the U.S. Supreme Court overturned Roe v. Wade in June, ending federal abortion protections.
While medical abortions are relatively common, accounting for more than half of all terminated pregnancies in the United States, providing the pills to patients who have not even conceived is a new frontier in the reproductive rights landscape.
“Everyone should be able to access a supportive, non-judgmental, and trusted abortion,” Choice CEO and nurse practitioner Cindy Adam said in a press release. “Unfortunately, we know that is not the case for the countless people who increasingly face barriers to accessing abortion care in the United States.”
The service, which the company calls “forecast,” is also available in California, New Mexico, Colorado and Maine.
In Illinois, patients must be 15 or older to access the service, according to the Choice website.
“We believe in the power of planning ahead and being prepared for the unexpected,” the website says. “Advance provision is a way for people to get abortion pills ahead of time in case they need them in the future.”
Patients complete an online questionnaire, which includes questions about their medical history. Questionnaires are reviewed within 48 hours by clinic health professionals; a medical provider will then text the patient to confirm the information and submit consent forms, the website says.
“Before approving a patient for prior provision of abortion pills, Choice reviews the patient’s health questionnaire to confirm that abortion medications would be safe for the patient based on their medical history,” Adam said in an email. -mail.
If a patient becomes pregnant in the future and decides to use the abortion pills, “we ask that she return to Choice for medical support and counseling throughout her abortion process,” Adam said.
Once the patient returns and completes a new medical intake, a clinician will assess the patient’s information to ensure it is still safe to take the medications, she said.
She added that health care providers review medical information such as the patient’s last menstrual period, any bleeding or other irregular symptoms, as well as indications that an ultrasound might be needed.
“Telehealth in general relies on mutual trust within the patient-provider relationship, and it is central to our approach to care at Choice,” Adam said. “We believe that our patients know their bodies and medical histories and want the best results for themselves.”
The drug costs between $175 and $350 including shipping. The pills ship in two to four business days, but can be shipped for a $25 fee, according to the website.
Choice, an online sexual and reproductive health clinic based in the San Francisco Bay Area, began offering medical abortions in 2020. The clinic’s healthcare providers include doctors and other clinicians.
Eric Scheidler, executive director of the Chicago-based Pro-Life Action League, called the service “a cynical marketing ploy to get women to effectively choose abortion before they’re even pregnant.”
“The American medical community is so drunk on abortion that they now want to sell abortion pills to women who aren’t even pregnant, disregarding the risks of providing treatment without any in-person consultation, and regardless of changes in medical history between the time of distribution and the time of use,” he said. “Furthermore, this proposal betrays a chilling hostility toward unborn children – as if pregnancy -even was a life-threatening medical condition.”
Medical abortions have been approved for use in early pregnancy since 2000 in the United States.
The process consists of a two-drug regimen: First, the patient takes mifepristone, which blocks the hormone progesterone to prevent the growth of the pregnancy. A day or two later, the patient takes the second pill, misoprostol, which causes the uterus to contract and the cervix to open slightly, expelling the pregnancy.
Until recently, the United States Food and Drug Administration required clinicians to dispense the first drug, mifepristone, in person at a medical facility, health care office, or hospital. The second pill, misoprostol, could be taken by the patient at home.
In a landmark change, the FDA in December overturned these regulations, allowing mifepristone to be sent directly to a patient, eliminating the need to leave home or go to a physical clinic to terminate a pregnancy.
This allows patients in some states, including Illinois, to get a prescription first during a telehealth visit and have the pills shipped directly to them. Mail-order services, however, are banned in many states due to the ban on medical abortion or abortion telehealth services, as well as other restrictions on termination of pregnancy.
The FDA policy change was welcomed by reproductive rights advocates but decried by abortion opponents, who argued in part that the decision would compromise the safety of pregnant patients.
“Every life is sacred: the lives of mothers and the lives of unborn children,” Archbishop William Lori of Baltimore, chairman of the United States Conference of Catholic Bishops’ Pro-Life Activities Committee, said in a statement. communicated. “Not only does this decision promote the tragic taking of unborn lives, it does little for the welfare of women in need. Far from the support that women in crisis deserve, this decision would leave women alone in the midst of trauma, often without medical care or follow-up care.
Planned Parenthood of Illinois began offering abortion pill services by mail to state residents who are 10 weeks or less pregnant in April. The patient first has a telehealth visit with a medical provider and must be physically in Illinois during that appointment, according to the agency. Then the drug is shipped to an address in Illinois.
“Medications will be shipped in discreet packaging to your address in Illinois and will arrive within two business days of your telehealth appointment,” Planned Parenthood of Illinois states on its website.
Out-of-state patients must travel to Illinois for their telehealth visit and then pick up the medications at an Illinois clinic, according to the agency.
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Many states restrict the use of abortion pills or outright ban telehealth services for terminating a pregnancy.
According to a report by the Guttmacher Institute, a research group that supports reproductive rights, nineteen states require a medical provider to be physically present when a medical abortion is administered, prohibiting the use of telemedicine.
In 2022, more than 100 restrictions have been introduced in 22 states, including seven provisions that would ban medical abortion entirely, according to the Guttmacher report. Some of the other measures would specifically ban the mailing of abortion pills or require doctors to perform medical abortions, instead of allowing other clinicians such as advanced practice nurses or medical assistants to do so.
It’s unclear, however, how states will enforce these regulations, as many websites and vendors in other countries offer the drugs online, sometimes without a prescription or medical information.
Medical abortions accounted for 54% of all pregnancy terminations in the United States in 2020, according to the Guttmacher Institute.
“However, medical abortion has become a primary target of anti-abortion politicians and activists seeking to restrict care in and out of clinical settings,” the report said. “Anti-abortion policymakers have shown their focus on further restricting access to medical abortion this year.”