Mail delivery of abortion pills is safe and convenient, study shows

Dispensing abortion pills through the mail works as well as requiring patients to get them in person from a clinic or doctor's office, according to new research from UC San Francisco, which comes as the Supreme Court is considering whether to disallow the practice. 

Researchers found that using a mail-order pharmacy to deliver the drugs after an in-person assessment was both safe and effective, and patients appreciated the privacy and convenience of receiving their abortion medication that way.

"The study provides additional evidence that the abortion medication mifepristone should be treated like every other medication and can be easily dispensed by pharmacists, including through a mail-order pharmacy," said Daniel Grossman, MD, a UCSF professor of Obstetrics, Gynecology, and Reproductive Sciences and director of the Advancing New Standards in Reproductive Health (ANSIRH) program. "Any attempt to restrict it is not based on science."

The findings were published May 13, 2024, in the journal JAMA Internal Medicine. 

The percentage of abortions that are done with medication, often via telemedicine, has grown rapidly in recent years, as the Food and Drug Administration (FDA) updated regulations on how the medication can be dispensed, and as many states have banned abortion. In 2023, nearly two-thirds of all abortions in the United States were done with medication. 

Sending abortion pills through the mail has only been allowed since the COVID-19 pandemic when the FDA removed the in-person dispensing requirement, first temporarily and then, based on the evidence of its safety, permanently. Before then, patients had to see a certified provider at a doctor's office, hospital, or clinic to get mifepristone, which is the first of the two drugs used in medication abortion.

Since most physicians do not store many medications in their offices, however, requiring them to keep mifepristone on hand impedes access. 

There is a lot of interest among gynecologists, as well as family medicine and internal medicine clinicians and pediatricians to be able to provide this care for their patients who need it. This model of care using a mail-order pharmacy can help them do that."

Daniel Grossman, MD, UCSF Professor of Obstetrics, Gynecology, and Reproductive Sciences 

No adverse events from mail-order dispensing

Researchers analyzed the experiences of 510 people who received mifepristone, which blocks progesterone, a hormone needed to continue pregnancy, and a second drug, misoprostol, which is used one to two days later to bring on contractions. 

Patients received the drugs through the mail after being seen at abortion and primary care clinics in seven states – California, Colorado, Delaware, Georgia, New York, Pennsylvania, and Rhode Island – between January of 2020 and May of 2022.

Researchers found that nearly 98% of patients had complete abortions, and there were no adverse events related to mail-order pharmacy dispensing. More than 85% of the participants received the medication within one to three days, a timeframe that 94% of the participants described as reasonable. And 96.6% said they were satisfied with mail-order dispensing. Almost all said their confidentiality was maintained through the shipping and delivery process.

After the Supreme Court ended the constitutional right to abortion in 2022, allowing state abortion bans to take effect, anti-abortion groups turned their sights on medication abortion. They sued the FDA to restrict mifepristone, despite extensive research supporting its safety and efficacy.

The case in front of the Supreme Court asks the justices to ratify a conservative federal appeals court ruling that would roll back the FDA regulations to require that mifepristone, which is only approved for use in medication abortion, be dispensed in person at a doctor's office, clinic, or hospital. The case does not involve misoprostol, which is approved for other indications. The high court heard oral arguments in March, but isn't expected to issue a decision until June.

In addition to making it harder for patients receiving in-person abortion care, a ruling that rolled back access to mifepristone would also affect virtual abortion providers since they would no longer be able to send it through the mail. 

In February, UCSF researchers published a study that found medication abortion can be delivered safely and effectively through telemedicine.