In a move that amplifies the debate over access to abortion in the United States, the Food and Drug Administration this week ruled that a drug used in the majority of abortions in the country can be dispensed by retail pharmacies to individuals with valid prescriptions.
Until the ruling, that drug, mifepristone, could be dispensed only by certified clinics and doctors’ offices, or by specific online pharmacies. Now, retail pharmacies, including those of major chains like CVS and Walgreens, will have the ability, though not the obligation, to carry the medication.
However, it will remain illegal for pharmacies to dispense the medication in at least 12 states, which have passed laws banning abortions.
Mifepristone blocks hormones that contribute to the development of a fetus. When a dose is followed one to two days later with a dose of a second drug, misoprostol, which induces muscle contractions, the result is an abortion. Known as a medical abortion, the two-pill regimen accounts for more than half of all abortions in the U.S. Both mifepristone and misoprostol have other uses unrelated to abortion.
The ruling came days after it was announced that the Justice Department had issued a finding, at the request of the U.S. Postal Service, that it is legal to use the U.S. mail to deliver mifepristone and misoprostol. That finding would apply regardless of the laws of individual states.
State laws differ
The Supreme Court’s ruling last year that abolished the federal right to an abortion, which was put in place by the 1973 court decision Roe v. Wade, left it to individual states to craft abortion laws themselves. This has led to a patchwork of abortion regulation across the country.
Sixteen states have adopted laws that ban all or practically all abortions. In those states, as well as in several others, laws restricting abortions would also make it illegal to sell mifepristone and misoprostol within their borders, regardless of the FDA’s position.
Other states have explicitly protected the right to abortion in their laws, with several amending their constitutions to do so.
If retail pharmacies opted to sell abortion drugs in states where they are legal, it would further widen the already large gap in abortion access in some parts of the country. In certain regions, particularly states in the Deep South, a woman seeking access to an abortion has to travel hundreds of miles to reach a state that has not banned the procedure.
Abortion rights activists cheered
Supporters of the right to an abortion said that they were encouraged by the FDA’s ruling.
“Today’s news is a step in the right direction for health equity. Being able to access your prescribed medication abortion through the mail or to pick it up in person from a pharmacy like any other prescription is a game-changer for people trying to access basic health care,” Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, said in a statement.
However, advocates also noted that the sale of the pills would remain illegal in 12 states, because of abortion bans passed by state legislatures.
“Today’s announcement means that people in states where abortion is legal will be able to consult with their health care providers and obtain medication abortion in the way that works best for them — whether it’s through their neighborhood pharmacy or through the mail,” Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement. “However, 12 states have banned abortion, and this move will not change anything for the people in those states, which is why Congress must pass the Women’s Health Protection Act to ensure the right to access abortion care is protected nationwide.”
Abortion-rights opponents unhappy
Groups that support the restriction or outright elimination of abortion in the U.S. were unhappy with the ruling, with some criticizing the administration of President Joe Biden over its support for abortion rights.
Although the medical establishment, including the FDA, has said that medical abortions are safe, anti-abortion-rights groups point to rare side effects, including heavy bleeding and infection, as proof that they are dangerous.
“Today’s announcement is yet another in a long train of actions the Biden administration has taken that put women at grave risk, in its headlong rush to push abortion drugs on the American public,” Steven H. Aden, chief legal officer and general counsel for Americans United for Life, said in a statement emailed to VOA.
“The Biden administration has once again proved that it values abortion industry profits over women’s safety and unborn children’s lives,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement.
Retail pharmacies consider options
It was not clear whether retail pharmacies, including those of large chains, would carry mifepristone and misoprostol in states that have not made abortion illegal. To do so, they would have to comply with special rules put forward by the FDA.
They would also have to assess the reputational costs and benefits of a decision that will likely have repercussions that extend beyond the balance sheet.
“We’re reviewing the FDA’s updated Risk Evaluation and Mitigation Strategy (REMS) drug safety program for mifepristone to determine the requirements to dispense in states that do not restrict the dispensing of medications prescribed for elective termination of pregnancy,” Amy Thibault, lead director of external communications for CVS Pharmacy, told VOA.
Fraser Engerman, a senior director for external relations with Walgreen Co., told VOA, “We look forward to reviewing the FDA’s announcement and mifepristone REMS program, and we will continue to enable our pharmacists to dispense medications consistent with federal and state law.”
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