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May 8, 20213 min read

What are the implications of the Biden administration's recent allowance of mailed abortion pills?

By: Lakshmi Sunder


There are two ways for abortions to be performed in the US legally (though the restrictions differ state-by-state) - via surgery or by taking the mifepristone or misoprostol pill. Abortions performed by ingesting a pill are generally less risky than surgical abortions because they are less invasive and don’t require a high sedative - they are especially preferred during Covid-19.


Studies have shown that prescribing abortions via telemedicine is similar to prescribing abortions in person, if not better. A long-term study done by Gynuity Health Projects found that “direct-to-patient telemedicine was safe, effective, and acceptable.” In the UK, where abortion restrictions have been loosened because of the pandemic, the British Journal of Obstetrics and Gynecology found that there was little difference between physically prescribed and virtually prescribed abortion pills when it came to safety or effectiveness. The latter has been found to be even more efficient. The journal had examined more than 52,000 abortions distributed virtually and found that patients waited an average of four days less to get an abortion when it was done via mail.


Recently, the Biden administration partially reversed the Trump administration’s stance on abortion and reproductive rights during the pandemic by allowing abortion pills to be prescribed virtually by doctors and then sent to patients by mail.


Conversely, in August of 2020, the Trump administration requested that the Supreme Court do the opposite of the Biden administration’s approach, leading to a requirement that individuals wanting to use mifepristone (also known as RU486) - one of the two approved abortion pills in the US - must visit a hospital, clinic, or medical office in order to receive the pill. They must also acknowledge in writing that they have been advised of the pill’s risks.


By January, the US Supreme Court successfully fulfilled the Trump administration’s proposed restrictions on reproductive rights by lifting an order done by a lower court that allowed the pill to be mailed or delivered. This was despite the rising number of COVID-19 cases and deaths, and the fact that going in person could potentially put these patients at risk.


The Biden administration has not immediately suspended Trump’s policy, something that some reproductive rights proponents desired. The administration believes that this more conservative approach will give the decision a better chance of being approved in court.


Because of this piecemeal strategy, the current legislation, remaining from the Trump era, will be imposed until it is officially replaced by the opposing policy.


If approved, what implications could the decision have on Americans?

On the spectrum of advocacy for reproductive rights, Biden’s decision to allow mifepristone to be prescribed and mailed to a patient is not all that radical.


The abortion pill can still only be taken in the first ten weeks of pregnancy - a point at which some people are still unaware that they are pregnant. Furthermore, this federal decision could be overpowered by state-to-state stances on reproductive rights: 19 states already have laws that prohibit telemedicine for prescribing abortion pills, and superseding those decisions could lead to lawsuits. However, most of this state legislation targets providers rather than the individuals requesting abortions. Plus, this restriction would only be temporary, lasting only until the pandemic ends, despite advocates pointing out that allowing abortion pills to be mailed has benefits beyond the pandemic. For instance, there could be long-term benefits for lower-income patients, who are often people of color and other minority groups, that must take time off work to travel and get a say-so from their doctors.


Despite these limitations, advocates for making abortion more accessible and safer hope that this decision made by the Biden administration will eventually be made permanent by the FDA. As it is, the proposal is a step in the right direction for reproductive rights in the United States.



Discussion Questions:

  • Will the Biden administration’s allowance of virtual prescription and by-mail distribution of abortion pills be enough to overpower the anti-abortion legislation in more conservative states?

  • What other countries have imposed this more liberal approach to abortion during the pandemic, and how has this approach been received?

  • Would an immediate suspension of Trump-era restrictions on abortion have been more effective, as some pro-choice advocates have proposed?

  • What are the chances of the FDA’s permanent approval of mifepristone delivery by mail, and what factors could play into this?

  • What is the general stance of doctors and other medical professionals when it comes to permitting an abortion via telemedicine?


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