Tara* has health insurance. Her health insurance even covers abortion—something of a rarity, considering that 11 states have laws restricting coverage of the procedure in private insurance plans, and 26 states restrict coverage in plans sold under the Affordable Care Act.
But when she found out she was pregnant, she realized she still wouldn’t be able to afford the cost of an in-clinic abortion: Since she hadn’t met her $1,500 deductible, she would have to pay for the entire procedure out of pocket, which would cost several hundred dollars.
“On paper I look like someone who could afford an abortion, which is weird to say. I make money, but I have to pay for rent, car payments, student loans, and health insurance—I don’t have the expendable income to just drop $600,” Tara told VICE.
She thought it over for a week—she could miss a car payment, or pay her rent late, but neither of these options were acceptable to her. Then she remembered she had read about Aid Access, a website run by a doctor based in the Netherlands who prescribes abortion pills for just $90. After one last attempt to scrape together the funds for an in-clinic procedure, she contacted the site.
Buying pills through Aid Access is designed to be simple and straightforward: First, Rebecca Gomperts, the doctor who started the service, has a consultation with U.S. patients over email to make sure they’re eligible to use the method. Then she writes a prescription for the pills, which patients email to a pharmacy she works with in India. Gomperts gives her patients instructions for how to use the medication, and when the pills come in the mail, they can take them at their convenience—but typically only during the first trimester. The U.S. Food and Drug Administration has approved medication abortion for use up to 10 weeks in pregnancy.
Gomperts started Aid Access to help people overcome the many obstacles to abortion care in the U.S., considering it her duty as a doctor to help people access the procedure. But because of the FDA’s restrictions on mifepristone, one of two drugs found in the abortion pill regimen, the service Aid Access provides is considered a violation of federal law, which is why Gomperts has an international—not a U.S.-based—pharmacy ship the pills. That means the drugs must go through U.S. Customs, which can delay them for an unpredictable amount of time: Some people receive their package in just a few days, but others may wait weeks for theirs to arrive. (Customs did not return VICE’s multiple requests for comment about whether it is targeting packages from Aid Access.)
Tara belonged to the latter group: She watched the medication sit in Customs for 16 days, an agonizing period of time during which she was growing more worried about whether she was still going to be able to end her pregnancy using the method she wanted.
“Those were the longest 16 days of my life,” she said.
Aid Access is currently considered the most reputable resource for self-managing an abortion. While there are several sites where people can buy abortion pills online, Aid Access is the most affordable—other websites charge anywhere between $115 to $430—and the only one operated by a licensed physician. On Plan C, a website that ranks online abortion pill retailers in a “report card,” Aid Access is the only site to receive an A.
One online abortion support group is filled with people’s accounts of using Gomperts’ service: Anyone who posts about not being able to access a clinic, be it for reasons of cost or distance, can expect to receive at least one response recommending Aid Access. The experiences detailed in this group are overwhelmingly positive. (VICE is not including the names of the online forums so as not to make them a target for shuttering.)
But while Aid Access may be the best option for people who find themselves needing—or preferring—to end their pregnancies on their own, the restrictions on mifepristone can put them in an impossible situation.
While three women VICE spoke to who used Aid Access were all ultimately successful in self-managing their abortions with pills from the site, some women online have described panicking about the wait time for the pills and going to a clinic after all, even if they still couldn’t afford it. And others—including one of the women in this story—said that they had used the abortion pills past the recommended time frame due to shipping delays.
The women who told VICE about using Aid Access said they don’t have any regrets about choosing the service, but their experiences were still characterized by feelings of stress and anxiety when days of waiting for a package of pills to arrive turned into weeks.
“Those were the longest 16 days of my life."
This is not a situation of Gomperts’ making; rather it is the result of the many restrictions on medication abortion, which doctors and reproductive health experts say are medically unnecessary.
“You’re in quite the nerve-wracking situation if you don’t find out you’re pregnant until six or seven weeks, and that’s often around the time when someone who isn’t planning for a pregnancy will find out,” said Abigail Aiken, an assistant professor at the University of Texas at Austin, who studies self-managed abortion. “If you have to wait three weeks for pills, you risk bumping up against that [10-week] cut-off point.”
Taking abortion pills past 10 weeks of pregnancy—and especially past 13 weeks—can mean heavier bleeding and raise the chances of an incomplete abortion, requiring patients to seek medical care afterward. Though such cases are rare, these caveats make the wait for abortion pills to arrive in the mail feel like a race against the clock.
“On top of the stress and anxiety of dealing with a pregnancy that’s not wanted, you have the added stress and anxiety of getting the pills,” Aiken said, not just because patients want to end the pregnancy as quickly as they can, but because they want to do it in the safest way possible.
Gomperts warns patients about the potential wait time for the pills: In the first email she sends people who request pills from her, she estimates the package will take seven to 21 days to arrive, and informs them that there is no faster shipping method available. She also urges patients to make their decision about whether they want to move forward with Aid Access as soon as possible, since she only treats patients who are less than nine weeks pregnant.
Have you experienced issues with U.S. Customs ordering abortion pills from Aid Access or another site? If you feel comfortable sharing your story, you can reach Marie Solis securely at firstname.lastname@example.org.
When Alex, who asked that VICE withhold her last name as a legal precaution, ordered abortion pills through Aid Access, she was about four weeks and five days along. Had the medication arrived in the estimated seven to 21 days, she would have been well within the 10-week window. But instead, her package remained in Customs for a full month; Gomperts ended up writing her a second prescription for the pills, but the first package arrived sooner: Alex took the pills when she was nine weeks and three days pregnant.
“I’d had a medication abortion once before with a clinic, but I was only about five weeks along at that time,” Alex said. “So I was kind of nervous [this time] because even though they say you can take the pills up to 13 weeks, things can get more complicated after the 10th week, and I didn’t want to complicate things.”
If the pills hadn’t come by the 13-week mark, Alex said she would have used the advance on her tax return to pay for an in-clinic procedure, even though she had been saving the money for a birthday gift for her three-year-old son.
“I had promised my son that we would redecorate his bedroom for his birthday,” she said. “It made me upset to think that I wouldn’t be able to do that, but I knew I wouldn’t be able to raise another kid by myself.”
Once patients have decided to end their pregnancy with Aid Access, they’re committed to seeing it through: Their back-up plans—like paying rent late in order to afford an in-clinic abortion—aren’t satisfactory to them because they weren’t satisfactory in the first place.
Even though Tara didn’t receive her pills until the 11-week mark, she was undeterred by the warnings about taking the pills past 10 weeks. She researched medication abortion past 10 weeks, looked up the signs of infection, and read about the experiences of other people who had been in a similar situation. She knew if she had any complications to just tell doctors that she had a miscarriage, to avoid possible criminalization for self-inducing an abortion.
“I was prepared for the worst outcome,” she continued. “I couldn’t have a baby so there wasn’t any other choice—no matter how long Customs made me wait I wasn’t having this baby and I didn’t have $600 to pay the clinic.”
Women like Tara and Alex face a difficult choice: wait an indeterminate amount of time for abortion pills to come in the mail, or find a way to get the pills from a clinic and suffer the financial consequences.
“I couldn’t have a baby so there wasn’t any other choice—no matter how long Customs made me wait I wasn’t having this baby and I didn’t have $600 to pay the clinic.”
There are other possibilities. Some of the sites that appear on Plan C’s report card have much faster ship times because they operate as online pharmacies rather than full-scale telemedicine services like Aid Access that require a consult. And because they sometimes ship from within the U.S.—flouting FDA rules—there’s no Customs checkpoint to hold up the packages. But pills from these pharmacies are more expensive, and don’t offer the comforts that come with having a licensed physician walk you through the process.
“It’s a bit of a trade off,” said Elisa Wells, the founder of Plan C. “Aid Access offers a really good price, physician support and excellent ongoing support in terms of instructions and answering questions. But there is this issue that the pills ship from overseas and they take longer to get to you. It’s not perfect, but people have to decide what’s important to them.”
Paige, who also asked VICE to withhold her last name, decided to make this compromise when contemplating how to end a recent pregnancy. The last time she’d gotten an abortion, she’d had a difficult time getting scheduled at a clinic, and ended up driving out of state for the procedure—when taking travel costs into account, she’d spent a total of $900.
“When it came to this recent pregnancy, I said, 'Fuck that,'” Paige said. “I was learning more and more about self-managed abortion online and I didn’t to fight with the limitations of clinics again.”
She ordered the pills from one of the online pharmacies reviewed by Plan C for about $250, which she paid according to the instructions of a man who called her.
“It was kind of a sketchy work-around, but I knew it was legit from the Plan C report card, and [the pills] were in my mailbox in four days,” she said. “No waiting for weeks, no waiting for an appointment. Waiting in my experience was the worst part of being pregnant when you don't want to be. The waiting is torture.”
Giving yourself a medication abortion doesn’t have to include weeks of waiting for a package to arrive in the mail, reproductive health advocates say: If the FDA lifted the restrictions on mifepristone, services like Gomperts’ would be free to operate in the U.S. And indeed some already are, through a clinical trial operating in 10 states, which exempts researchers from the FDA regulations.
"Aid Access really is demonstrating a way forward for safe and effective and convenient access to abortion services for the U.S.," Wells said. "It’s a model we need to see made available here through regular medical channels so we don’t end up having the delay."
In the end, neither Tara nor Alex had any complications passing their pregnancy—and they both described feeling happy and immensely relieved not to be pregnant anymore.
“It took a huge weight off of my shoulders,” Tara said. “I felt present for the first time in three weeks.”
*Name has been changed.
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