Abortion pill websites and providers are seeing a surge of interest following a series of court decisions that threaten to block access to one of the major abortion drugs, mifepristone.
Carafem, a national abortion provider with a wide range of telehealth services, said it had seen a 38% increase in people booking virtual appointments since the first ruling on Friday upending the FDA’s 2000 approval of mifepristone. Many customers have been asking whether they can order abortion medication before becoming pregnant – what is known as “advance provision”, a number of providers said.
The online provider Hey Jane says it has seen a 30% increase in patients in the last week and a 58% increase in traffic to its website, while the website Plan C has seen an almost twofold increase in traffic to its website since the decision. More than half of the visitors to Plan C viewed the organization’s guide on how to order abortion pills online. And the online abortion telehealth provider Choix says it had seen as many patients asking about the advance provision of abortion pills since Friday as it usually sees in a month.
On Wednesday, the fifth circuit court of appeals ruled to impose restrictions on mifepristone that include lowering the use of the drug to seven weeks of pregnancy instead of the current 10-week limit, and requiring in-person doctor visits for those looking to obtain the drug. The Biden administration subsequently expressed its intention to immediately appeal that decision before the US supreme court.
The providers told the Guardian they were studying the implications of the appellate court’s decision, while news of whether the case will be heard in the supreme court is pending. A number of them use telehealth to see patients and the mail to ship the pills.
On Friday, Judge Matthew Kacsmaryk ruled in favor of anti-abortion groups challenging the Food and Drug Administration’s 23-year-old approval of mifepristone – a drug commonly prescribed alongside misoprostol to induce an abortion. The Biden administration appealed the decision, and an appeals court ruled late on Wednesday that the drug can remain available, but with significant restrictions.
On the same day as Kacsmaryk’s decision, a federal judge in Washington state issued a conflicting ruling, stating that the FDA is not to take any action that would affect the availability of mifepristone.
The dueling decisions increase the likelihood that the issue of mifepristone’s FDA authorization will ultimately be decided by the supreme court.
“Advance provision helps to alleviate the stress and barriers that comes with accessing a highly stigmatized and politicized form of care – even in states where it remains legal,” said Cindy Adam, CEO of Choix, which has been at the forefront of advocating for advanced provision.
“We know that recent uptake in utilization correlates with the mifepristone case, and, in general, we see spikes in interest when there is more information shared about attacks on reproductive rights in the press and social media,” she added.
Research published by WeCount on Tuesday showed that the number of legal abortions performed in the US dropped by 6% since Roe v Wade was overturned in June 2022. That data does not account for people accessing pills outside the healthcare system, or through advance provision, which probably offsets the drop to some extent.
There has been a longstanding debate about the safety of doctors prescribing medication abortion in advance of pregnancy. Many drugs are prescribed in advance – for example, antibiotics can be prescribed in advance in cases where a patient repeatedly gets the same infection, or ahead of travel. Many abortion providers argue that US restrictions on medication abortion are overly burdensome and not in keeping with the rest of the world. But the FDA has argued against advance provision of mifepristone in the US.
Generally, two drugs are used in combination to induce an abortion: mifepristone and misoprostol. Misoprostol can be prescribed on its own to induce an abortion, but it is thought to be slightly less effective and more painful, and it is more likely to require follow-up care than when it is used in combination with mifepristone. Some providers have said they will continue prescribing misoprostol should Kacsmaryk’s ruling impair access to mifepristone.
But other providers have vowed to continue to prescribe mifepristone as long as they can, and a number of Democratic states have begun stockpiling the pill in response to Kacsmaryk’s ruling.
“We want patients to know that in the meantime, Carafem is still providing mifepristone and misoprostol to our clients that want to have medication abortion. We did so last week, we’re doing so this week and we look to continue to do that until we get a message from the FDA that we’re unable to offer that medication any more,” stated Carafem’s CEO, Melissa Grant.
“If we get a message to stop, we are able to pivot to offering misoprostol alone, and if necessary, we will flex to be able to accommodate more people in person.”
