The rise of medical abortions in the US

Rebecca Gomperts, a Dutch physician practising in Austria, says that she has heard from thousands of pregnant women in the United States in recent months who want abortions but cannot get them. In many cases, they simply do not have the hundreds of dollars it takes to get an abortion in the US, she told The BMJ. Others live far from the specialised clinics where many abortions take place. “Some would have to travel six hours,” she says.

So Gomperts offers a service that the US Food and Drug Administration says is illegal but that she and her supporters say is necessary: she writes prescriptions for abortion drugs to be mailed from a pharmacy in India to women in the US.

She runs a global online consultation service, called Aid Access, outside the bounds of the US medical system. Others are working within those bounds with similar goals: to expand the use of medical abortion to fill access gaps.

Those gaps could grow under a spate of new, currently unenforceable state laws aimed at convincing the US Supreme Court to overturn Roe v Wade, a 1973 decision that says abortion is a constitutional right.

Currently, medical and surgical abortions remain legal everywhere in the US, but individual states can and do impose restrictions. Many states ban late abortions, impose waiting periods, mandate counselling, and require parental consent for minors. Federal law also limits the distribution of abortion drugs to authorised providers: women cannot pick them up in pharmacies or get them through the mail, except as part of some research projects.

Despite the restrictions, medical abortions, which are allowed in …