During the early stages of the epidemic, reproductive health professionals spearheaded a campaign to make at-home abortions available to more Washington women.

The Biden administration overturned a Trump-era restriction that made it illegal for doctors to remotely prescribe mifepristone, one of two medicines widely used in medication abortion, in April. Since March 2020, when physicians shifted to telehealth during the pandemic, abortion treatment has been available in the same way as other types of health care. While physicians in Washington state and around the country have welcomed the new medication abortion by mail delivery system, activists warn access remains far from universal, even in the Pacific Northwest.

That may come as a surprise to some. Washington defies national anti-abortion laws by providing abortion insurance and Medicaid coverage, as well as state-level safeguards to make abortion lawful if Roe v. Wade is reversed. However, according to data from the Guttmacher Institute, a reproductive health policy group, 59 percent of counties in Washington, where 10% of women live, lack an abortion facility.

Medication abortion by mail is a novel approach for persons in underprivileged locations to get care. Patients in Washington may now seek therapy via digital clinics such as Hey Jane or virtual consultations with established local brick-and-mortar clinics such as Cedar River, which has sites in Seattle, Tacoma, and Renton. Because medication abortions commonly use mifepristone and a second medicine, misoprostol, making the pills available by mail allows people to undergo abortions safely at home without having to drive to a clinic.

During the pandemic, several family planning doctors around the US were "putting in procedures to give no-touch medication abortion so patients could access treatment without having to come on site," according to Ying Zhang, a family medicine physician located in Seattle.

This would not have been conceivable prior to the Biden administration's change of heart. Mifepristone had previously been subjected to a Risk Evaluation and Mitigation Strategy, or REMS, a limitation limiting distribution to certain providers in hospitals, medical offices, and clinics. That means the medicine hasn't been available in pharmacies, despite the American College of Obstetricians and Gynecologists' protests that "there is no safety basis for the restrictions."

However, when the FDA temporarily lifted the REMS on mifepristone under the Biden administration's purview, FDA Acting Commissioner Janet Woodcock affirmed in a letter to the obstetricians and gynecologists group that existing data did "not appear to show rises in serious safety concerns... occurring with medical abortion as a matter of fact of modifying the in-person distributing requirement during the COVID-19 pandemic."

With the REMS no longer an issue, some patients and doctors have found it considerably simpler to administer telemedicine medication abortion. "Without the [REMS] injunction, patients would have had to come on-site to acquire the medicine," Zhang explained. They no longer have to.

34 states either outright prohibit medication abortion or require that it be performed in the presence of a doctor. A lack of providers ready to provide abortion care is exacerbated by a lack of local providers.
Idaho is one of the few states that require a doctor to prescribe mifepristone and misoprostol. The practicalities are exacerbated further by a scarcity of clinicians ready to provide abortion care.

The FDA's decision to authorize pharmaceutical abortion through the mail is supposed to be temporary, lasting just as long as the epidemic lasts. If the regulation reverts to Trump-era limits, self-managed abortion may be the only option for some patients seeking medication abortion through the mail. Aid Access both give information on where people may get abortion medicines online.

"All these politicians putting in limits and prohibiting abortion — it's not going to end abortion in our nation," Zhang said. People will develop methods to look after themselves."

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