Online abortion pill dispensaries are spending mere minutes with abortion clients with little to no follow-up, despite potential complications associated with the abortion pill, some even leading to death — according to virtual abortion pill organizations interviewed in Ms. Magazine’s “online provider series.”
Under the Food and Drug Administration’s (FDA) REMS safety system, providers of the abortion pill must sign a prescriber agreement with manufacturer Danco Laboratories and generic manufacturer GenBioPro, which requires them to accurately “assess the duration of pregnancy” and “diagnose ectopic pregnancies” — something the industry claims can be done under a no-touch, no-test protocol.
Minutes spent with clients who rarely follow up
Carafem’s Melissa Grant told Ms. Magazine that their online process “takes maybe 15-20 minutes, if that.” She also claimed that the “majority” of Carafem clients “follow up because we contact them proactively.” Dr. Jamie Phifer, founder and medical director of Abortion On Demand (AOD), claimed to Ms. Magazine that AOD does “really close follow-ups” by sending clients an “automated follow-up by text” with “a secure survey link that’s tied directly to their cell phone number.” She later told Ms., “Patients, a lot of them, don’t need a lot of counseling.”
Christie Pitney of Forward Midwifery, a MYA Network member, told Ms. Magazine that they spend an average of “five minutes or less” with most abortion pill clients. She also admitted, “We don’t schedule any sort of follow up. We tell the patients that they can call us at any time, though.” Pitney then added that Forward Midwifery abortion clients “[r]arely[,] [l]ess than 10 times ever” follow-up after taking the pills.
Abortionist Michele Gomez, MD, a MYA Network co-founder and a self-proclaimed “activist physician,” told Ms. Magazine that her online process takes around “ten minutes.” On providing follow-up care, Gomez told the magazine that she has “gone back and forth,” before acknowledging, “I now just recommend that patients follow up with me if something doesn’t go as planned.”
Dr. Deborah Oyer, medical director of Cedar River Clinics, told Ms. Magazine that she spends “up to 30 minutes” with her abortion pill clients unless they are on their “third medication abortion,” and then claimed, “it can be done in a few minutes.”
Dr. Julie Amaon, medical director at Just the Pill, told Ms. Magazine, “About 80 to 85 percent of people find us on Google, just by searching. That’s how we advertise.” She also claimed her online appointment process takes around 15 minutes while just 50% of her abortion clients do the follow up care. Based on Amaon’s claims, Google appears to be allowing unregulated abortion pill dispensaries to advertise on their platform while censoring ads promoting Abortion Pill Reversal (APR).
Robin Tucker, a nurse practitioner also associated with MYA Network, offers abortion pills by telehealth at Metro Area Advanced Practice Healthcare. Tucker told Ms. Magazine she spends “10 or 15 minutes” with abortion pill clients and acknowledged that “most people don’t schedule” a follow-up. Tucker, who started providing abortion pills with Aid Access and the group Access Delivered, also told Ms. Magazine, “I think it’s great to be able to do births and then get back online and do an abortion case. I love that.”
Concern brick and mortar facilities will close
Phifer acknowledged to Ms. Magazine that her “per patient cost is relatively low” at Abortion on Demand — so low that rather than cut the cost to abortion clients, AOD donates “60 percent of our profits to Keep Our Clinics of the Abortion Care Network.”
Phifer also expressed concern that virtual abortion pill dispensaries may be impacting the survival of brick-and-mortar facilities. “I’m concerned about the impacts telemedicine abortion may have on brick-and-mortar clinics. Our costs of providing care are lower. We’re not paying insurance on a building. We don’t have a facility per se. We don’t have many staff,” Phifer stated. “I just got off the phone with a brick-and-mortar practice that was forced to triple their marketing budget to stay afloat due to aggressive marketing by a telehealth start up in their state.”
Limited follow-up care
PillsbyPost.com founder Razel Remen was initially “tempted” to offer the abortion pill up to “12 weeks” but told Ms. Magazine she only plans to offer chemical abortion pills through 11 weeks of pregnancy, a week longer than what was approved by the Food and Drug Administration’s (FDA) safety regulation (REMS). At 11 weeks of pregnancy, even Planned Parenthood admits that the abortion pill fails 13 percent of the time — nearly double the failure rate for the abortion pill given just two weeks earlier.
“I send eight misoprostol pills if someone is below nine weeks and 12 if they’re above nine weeks, so if they have an issue, they have it if they need it,” Remen told Ms. Magazine.
Under the REMS, prescribers are supposed to ensure women can obtain emergency care should there be a failure or complication. But Remen told Ms. Magazine that while her initial call selling the pill lasts 15 to 20 minutes per client, she is too busy during the day to take any follow-up calls from her abortion clients, some mof who may be teens.
“If they need assistance, I recommend that they call the Miscarriage and Abortion Hotline during the day because I’m in clinic and I might not be able to answer the phone,” Remen stated. “But if it’s after business hours, then they can just call me directly with any questions they might have.”
Remen admits that some of her abortion pill clients are calling from as far away as Texas, where she clearly cannot assist if an emergency arises. “I’ve noticed patient with IDs from outside of the states I serve are asking for medication. I don’t inquire as to where they are as long as their shipping address is in a state where I’m licensed,” she told Ms. Magazine.
Remen claims that she does call clients “two days” after they take the pills but acknowledged she has had issues. “I had one person who was very anxious and they weren’t sure as to whether or not the medication worked. So we worked through that to try to figure out where they could get an ultrasound if they needed it. I think it’s really essential for the entire movement to compile a database of pro-choice, friendly, inexpensive places where people can go to get ultrasounds.”
Abortion pill safety
The skytocketing growth of unregulated virtual abortion pill dispensaries is due in part to the FDA’s recent move to weaken important safety requirements on the abortion pill and permanently allow the pills to be shipped through the mail.
Despite the perceived ease of ordering abortion pills online, abortion by mail can pose potential serious complications for women and teens who purchase them without close medical oversight. Failure rates for the abortion pill can vary by gestation, but if the pill does fail, a woman could experience severe infection from an incomplete abortion. In addition, eliminating important exams, testing and labs can result in misdiagnosing a dangerous ectopic pregnancy. In addition, failure to test for Rh negative blood without treatment could put a woman’s future pregnancies at risk.
Women who do at-home abortions often report to an emergency room when a complication arises. This was confirmed recently in an analysis of adverse events reports (AERs) submitted to the FDA by abortion pill manufacturer Danco. The analysis revealed that abortion pill clients experiencing complications are more likely to receive care from an emergency center than from the abortion facility where they obtained the pills. It is likely that, due to the impersonal nature of online abortion pill purchases, this trend will continue.
Editor’s Note, 3/14/22: Added section regarding Pills by Post.
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