\n<\/p>\n
Angel Foster had a backup plan.<\/p>\n
It was the first weekend in May. A federal appeals court had just made it illegal to mail mifepristone<\/a>, a pill that\u2019s part of the most widely used abortion method in the U.S.<\/p>\n But Foster, a doctor who specializes in reproductive health, was prepared. As leader of the Massachusetts Medication Abortion Access Project<\/a>, which ships abortion pills to some 3,500 patients a month nationwide, including in states with abortion bans, she told patients they had three options.<\/p>\n They could get a refund. They could wait to see if the legal situation changed. Or she could ship them only misoprostol \u2014 a second drug already used in most medication abortions. Combined, mifepristone and misoprostol are considered the \u201cgold standard.\u201d Misoprostol can be taken alone to induce an abortion, but some studies have suggested it\u2019s less effective, Foster warned patients. Plus, it can make the process longer and more painful, with more side effects, such as nausea and vomiting.<\/p>\n Still, the vast majority of patients said the same thing: Just send it.<\/p>\n \u201cThey didn\u2019t care,\u201d Foster said. \u201cTheir response was: \u2018Whatever can get to me the fastest.\u2019\u201d<\/p>\n Two developments often get lost in the public\u2019s perception of the abortion wars. One is that the number of abortions in the U.S. has increased dramatically year over year since the Supreme Court overturned Roe v. Wade<\/em> in 2022, according to the Society of Family Planning\u2019s latest #WeCount report<\/a>. By December, 29% of abortions were through telehealth. The second is that, because the mailing of abortion pills has become so widespread in the post-Dobbs<\/em> era, abortion opponents may simply be unable to stop it.<\/p>\n Massive legal battles are being waged by states with abortion bans, seeking to block the shipment of mifepristone across their borders. In a suit brought by Louisiana, the U.S. Supreme Court recently restored telehealth access to mifepristone while a lower court hears the case. And abortion opponents continue their push to get the Trump administration to crack down on the pills\u2019 availability, either through a Food and Drug Administration safety review or more drastic measures.<\/p>\n But many telehealth experts who help patients get abortions aren\u2019t too worried.<\/p>\n \u201cWe like to say the genie is out of the bottle,\u201d said Elisa Wells, who co-founded and is the access director at Plan C<\/a>, which provides information about accessing abortion pills online.<\/p>\n \u201cNow that people know that they can get safe, fast, effective, affordable care through the mail, there\u2019s no going back,\u201d Wells said.<\/p>\n If mifepristone is restricted, many telehealth groups will immediately switch to using only misoprostol instead, they say.<\/p>\n Misoprostol is approved by the FDA to treat ulcers and is also widely used off-label to manage miscarriages, induce labor, and end pregnancies. And while states could individually ban misoprostol, the FDA doesn\u2019t typically regulate how a drug is used off-label, according to David Cohen<\/a>, a law professor at Drexel University and national expert on abortion law.<\/p>\n \u201cThere would have to be some finding that it is not safe or effective for ulcer treatment, something that there\u2019s no argument anyone could possibly show,\u201d Cohen said.<\/p>\n