Aid Access is a

nonprofit organization A nonprofit organization (NPO) or non-profit organisation, also known as a non-business entity, not-for-profit organization, or nonprofit institution, is a legal entity organized and operated for a collective, public or social benefit, in co ...

that provides access to

medication abortion A medical abortion, also known as medication abortion, occurs when drugs (medication) are used to bring about an abortion. Medical abortions are an alternative to surgical abortions such as vacuum aspiration or dilation and curettage. Medical ...

mail The mail or post is a system for physically transporting postcards, letter (message), letters, and parcel (package), parcels. A postal service can be private or public, though many governments place restrictions on private systems. Since the mid ...

to the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...

and worldwide. It describes its work as a

harm reduction Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to de ...

strategy designed to provide safe access to

mifepristone Mifepristone, also known as RU-486, is a medication typically used in combination with misoprostol to bring about a medical abortion during pregnancy and manage early miscarriage. This combination is 97% effective during the first 63 days of p ...

and

misoprostol Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. Misoprostol is taken by mouth wh ...

for people susceptible to pregnancy in the United States who may not otherwise have access to

abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregn ...

miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...

management services. People are able to manage their own abortion with remote access to a physician and a help-desk for any questions. The website is available in

English English usually refers to: * English language * English people English may also refer to: Peoples, culture, and language * ''English'', an adjective for something of, from, or related to England ** English national ide ...

Spanish Spanish might refer to: * Items from or related to Spain: **Spaniards are a nation and ethnic group indigenous to Spain **Spanish language, spoken in Spain and many Latin American countries **Spanish cuisine Other places * Spanish, Ontario, Can ...

, and

Dutch Dutch commonly refers to: * Something of, from, or related to the Netherlands * Dutch people () * Dutch language () Dutch may also refer to: Places * Dutch, West Virginia, a community in the United States * Pennsylvania Dutch Country People E ...

. Aid Access was founded by

Rebecca Gomperts Rebecca Gomperts (born 1966) is a Dutch physician and activist for women's rights, in particular abortion rights. She is the founder of Women on Waves and Women on Web, which provide reproductive health services for women in countries where thes ...

, a

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

, in March 2018. In 2019, Aid Access received a warning letter from the

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...

(FDA) stating that they were not authorized to distribute generic mifeprestone in the US. Aid Access in turn sued the FDA, stating that they were helping women exercise their constitutional right to abortion. The FDA pursued no further legal action, and the lawsuit ended. Over subsequent years, the number of requests for their service has risen to average over 100 per day. In 2021, they started offering "advanced provision" pills, whereby someone can order the pills ahead of time in case they might need them in the future.

History

Gomperts, a

based in the

Netherlands ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...

, started Aid Access in March 2018, to provide access to medication abortion in countries like the United States where abortion is legal but may be hard to access. Aid Access was incorporated in Austria, where Gomperts is registered to practice medicine. In October 2018, after six months of non-publicized operation, Gomperts stated that she had fulfilled about 600 requests for pills (an average of 3 per day). By February 2022, she said that she had served over 30,000 people in the US.

2019 FDA warning letter and lawsuit

In March 2019, the United States

(FDA) sent AidAccess.org a letter warning it to cease selling the

generic drug A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active ch ...

mifepristone, which they said was a "misbranded and unapproved new drug" in the United States. In a statement three days later, the

National Women's Health Network The National Women's Health Network (NWHN) is a non-profit women's health advocacy organization located in Washington, D.C. It was founded in 1975 by Barbara Seaman, Alice Wolfson, Belita Cowan, Mary Howell, and Phyllis Chesler. The stated missi ...

stated that this was a politicized attack against medical abortion, rather than a broader attempt to curb online drug sales. In May 2019, over 100

anti-abortion Anti-abortion movements, also self-styled as pro-life or abolitionist movements, are involved in the abortion debate advocating against the practice of abortion and its legality. Many anti-abortion movements began as countermovements in respons ...

members of

Congress A congress is a formal meeting of the representatives of different countries, constituent states, organizations, trade unions, political parties, or other groups. The term originated in Late Middle English to denote an encounter (meeting of a ...

sent a letter thanking the

Trump administration Donald Trump's tenure as the List of presidents of the United States, 45th president of the United States began with Inauguration of Donald Trump, his inauguration on January 20, 2017, and ended on January 20, 2021. Trump, a Republican Party ...

and the FDA for this action, even though major medical organizations stated that medication abortion is safe for use at home and should be more readily available. Gomperts did not comply with the warning and stated that she was not selling medications in the United States, since she sent the prescriptions to an independent pharmacy, which then dispensed the medications. In September 2019, on behalf of Aid Access, Gomperts sued the FDA,

Alex Azar Alex Michael Azar II (; born June 17, 1967) is an American attorney, businessman, lobbyist, and former pharmaceutical executive who served as the United States secretary of health and human services from 2018 to 2021. Azar was nominated to his p ...

(then secretary for the

Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is " ...

) as well as other federal officials for seizing several packages containing medications and blocking transfer of some payments to Aid Access. The goals of the suit were to stop these actions as well as to stop FDA prosecution of Gomperts and Aid Access in providing constitutionally protected abortion access. In November 2019, the FDA filed a motion to dismiss the suit that was followed in December 2019 by a response letter from Aid Access to the FDA. The presiding judge accepted the FDA's position that this case was about a person's right to any unapproved drug and not about a woman's right to an abortion, and, because the FDA had not taken any subsequent action following its letter, dismissed the lawsuit.

Studies

Data from Aid Access has been used in several studies because they had been the sole online abortion telemedicine service in the United States until April 2021, when the FDA (due to COVID-19) temporarily legalized delivery of medication abortion by telemedicine and mail (the FDA in December 2021 made it permanently legal). A study of the reasons given for requesting a self-managed abortion by the 57,506 individuals who requested this service between March 20, 2018, and March 20, 2020 found the reasons for requests to be: lower cost compared to a clinic (74%), privacy (49%), distance to a clinic (40%), and difficulty getting time off work or school (38%). Some also stated a preference for an at home, self managed abortion with 28% saying they would be more comfortable, and 27% saying it would be more convenient. Another study that included the 49,935 requests made through the online consultation form between January 1, 2019 and April 11, 2020 found that during the 2020

COVID-19 lockdowns Due to the COVID-19 pandemic, a number of non-pharmaceutical interventions colloquially known as lockdowns (encompassing stay-at-home orders, curfews, quarantines, and similar societal restrictions) have been implemented in numerous countrie ...

and restrictions (March 20, 2020, to April 11, 2020), average daily requests increased 27% compared to the preceding 14 months. In a third study covering the period between October 1, 2020, and December 31, 2021, Aid Access received 45,908 requests from across all 50 USA states. In the first week of September 2021, after Texas

Senate Bill 8 The Texas Heartbeat Act, Senate Bill 8 (SB 8), is an act of the Texas Legislature that bans abortion after the detection of embryonic or fetal cardiac activity, which normally occurs after about six weeks of pregnancy. The law took effect ...

went into effect, the mean daily requests from Texas spiked by 1200%, (from 11 to 140) gradually decreasing over the next three months to 30 per day (175% higher than the pre-Senate Bill 8 level).

Services provided

Aid Access offers

in combination with

, and misoprostol alone for medical abortion. Services available depend on the state in which the person lives. An online consultation process is required, which includes questions to assess for the medical eligibility and safety of providing medical abortion by mail. In states where telemedical abortion services are allowed, US based doctors work with Aid Access to provide pills directly and quickly to residents of their state. In most other states, an overseas physician provides a prescription and instructions for it to be filled with a

pharmacy Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links heal ...

India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...

, which then mails the medication to the patient in the United States.Conaboy, Chelsea,
The Doctor Prescribing Abortions from Overseas
',

Politico ''Politico'' (stylized in all caps), known originally as ''The Politico'', is an American, German-owned political journalism newspaper company based in Arlington County, Virginia, that covers politics and policy in the United States and intern ...

, June 3, 2022 Due to shipping from outside of the United States, sometimes it may take three weeks for the pills to arrive. After Texas passed

, Aid Access started offering "advanced provision" pills, so that someone can receive pills now to have the pills on hand if they should need them at a future occasion, a practice that Gomperts hopes more doctors will start doing. She believes that a way around the restrictive abortion laws is for all doctors to prescribe a set of abortion pills for a woman on her first

menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hor ...

, so that she will always have them if needed.

Safety

There are no data addressing the safety of Aid Access in particular.

Self-induced abortion A self-induced abortion (also called a self-managed abortion, or sometimes a self-induced miscarriage) is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortion ...

with mifepristone and misoprostol can be performed safely, according to the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...

(WHO). The WHO recommends that determination of eligibility for medical abortion is made by a health provider, but self-administering the medications at home and self-assessing the completion of the abortion are recommended in specific circumstances. This aligns with the care provided by Aid Access.{{ r , Atlantic_2018-10-18

References

Abortion providers Organizations established in 2018