Advance provision is a way for people to request abortion pills in advance – before they need them. By having pills on hand, they can use them soon after they discover they are pregnant. Choix offers advance provision of medication abortion pills via telehealth to help people access comprehensive abortion care. While no one can predict the future of reproductive health in the U.S., advance provision is likely to become a greater part of abortion care in our country for several reasons. Primarily, the growing legal challenges to accessing abortion make medication abortion a more realistic option for many people. The safety, efficacy, convenience, affordability, and confidentiality of advance provision of abortion pills all make it an attractive option for anyone seeking the power to determine their own reproductive freedom in the U.S. today.

More People Had Medication Abortions Even Before Roe vs. Wade was Overturned

Medication abortion is the nonsurgical option for ending a pregnancy in the first trimester (FDA approved for up to 10 weeks from the first day of your last menstrual period, but is used safely off label at later in pregnancy ). The U.S. Food and Drug Administration (FDA) approved a protocol of two medications (mifepristone and misoprostol) taken 24-48 hours apart as the safest and most effective form of medication abortion back in 2016.

Even before the U.S. Supreme Court overturned Roe v. Wade in June 2022, most people in the U.S. took medication to end their pregnancy rather than having an in-clinic surgical abortion. The FDA also permanently approved the mailing of mifepristone and misoprostol on December 16, 2021 after temporarily allowing it during the COVID-19 pandemic. The overwhelming success of mailing medication abortion pills in terms of client satisfaction, safety, lack of complications, reduced health care costs, and reduced burden on the health care system drove the FDA’s decision. In addition, receiving abortion pills in the mail without an in-clinic visit removes numerous barriers for many people, making telehealth abortion clinics like Choix an essential part of the future of abortion care in the US.

People are satisfied with the experience of medication abortion – a study of 4500 people reported more than 85% were glad they chose medication abortion.

Choix’s abortion providers and founders recognized how medication abortions make more sense for so many people. So they created Choix – to make comprehensive medication abortion care convenient, accessible, safe, and affordable.

Choix providers have been offering the FDA-approved medication abortion protocol to people who are pregnant and decide that medication abortion is right for them after they complete a brief, confidential medical history via text. Now they are offering advance provision of medication abortion pills for the same reason – to keep the kind of abortion care people want accessible for as many people as possible, despite changing laws and new obstacles.

Accessing Safe, Affordable, Supportive Abortion Care Quickly in the U.S. is No Longer Possible

The list of barriers standing in the way of people accessing abortions in the U.S. is long, and growing as trigger laws go into effect around the country. Barriers may include a combination of one, some, or all of the following: geographic, logistic, or financial barriers, legal or policy restrictions, or a lack of availability of clinicians or open clinics. Life is complicated for all of us – much more so for some more than others, depending on where we live, our skin color, our economic or citizenship status, and the language we speak.

Timing matters when it comes to medication abortion. The process is safer (fewer complications) and more effective (fewer incomplete or unsuccessful abortions) when pills are taken between 5 weeks and 10 weeks after the last menstrual period. The reality is that the majority of people do not learn they are pregnant until after their first missed period, usually 4-5 weeks into a pregnancy. Many clinics have long waiting times for initial appointments. Even in some states where abortion remains legal, wait times for appointments are long because of increased demand and their close proximity to states that have banned abortions.

Other states (35 in the U.S.) require waiting periods ranging from 24 to 72 hours, which necessitate multiple clinic appointments for an abortion. When adding in traveling long distances – potentially across state lines, arranging overnight accommodations, days off from work, and childcare –many people quickly find themselves bumping up against that 10 week limit. In addition, we know that a greater distance to abortion facilities is associated with more significant out-of-pocket costs, emergency room follow-up care, harmful mental health effects, and delayed care among U.S. abortion patients.

Experience has shown us that restrictions limiting abortion access contributes to increases in gestational age at abortion. This in turn limits how many people are eligible for medication abortion, reducing options and access. Both in-clinic surgical and medication abortion can already be expensive and pose a significant financial barrier for many people. Second and third-trimester surgical abortions are more expensive than first-trimester abortions, can involve multiple days, and are not offered by all clinics, increasing travel costs. The cost of an abortion becomes more of a barrier with each additional gestational week of pregnancy.

That is where advance provision helps relieve some timing obstacles when it comes to medication abortion. Advance provision puts the abortion pills in your hand when you need them – no hassle or last-minute scrambling. Instead you can be empowered to choose whether you want end a pregnancy on your own, supported by Choix’s expert abortion care clinicians.

Advance Provision is Safe

Choix believes in people choosing whether medication abortion is right for them on their own terms. And we are committed to supporting advance provision clients through the medication process if they decide to take the pills. This is what the WHO defines as comprehensive care – the safest kind of abortion care. Choix clinicians review clients’ medical history and pregnancy details (like the timing of the last menstrual period) to make sure that medication abortion is still safe for them to use at that time. They are available to answer any questions and talk with you about any concerns you may have before, during, and after your medication abortion.

Finding a safe, reputable abortion provider online isn’t always easy. Mifepristone and misoprostol can be found online for purchase on various websites. Depending on the sites, there may be very little medical or clinical oversight. According to the National Association of Boards of Pharmacy ( NABP), nearly 90% of internet pharmacy sites do not comply with the United States pharmacy laws and standards. Advance provision from Choix makes accessing medication abortion pills safer because all patients are screened by licensed nurse practitioners or nurse-midwives for any reasons why medication abortion would not be safe for them. Choix’s medications are sourced through an independently-certified and US licensed pharmacy selling only FDA-approved medications. Clients receive detailed instructions about how to take the medicines according to the FDA-approved protocol and can contact Choix providers with any concerns or questions. Advance provision of medication abortion pills through Choix telehealth means people will never have to be on their own when they take the abortion pills.

Advance Provision of Medication is Not New and Works for Emergency Contraception

Advance provision is not a new concept in reproductive healthcare. Many health care providers and public health experts dispense emergency contraception (aka the morning after pill or Plan B) ahead of when it may be needed. The lack of any serious complications or problems with advance provision of emergency contraception is evidence that in the reproductive health context, advance provision makes sense.

Advance provision is ideal for both emergency contraception and medication abortion pills because both are safe medications with few contraindications (reasons for a person to not receive a particular treatment because it may be harmful to them) or life-threatening complications. Both are safer, in fact, than some over-the-counter medications such as Tylenol.

Another reason why advance provision makes sense for both emergency contraception and medication abortion is because timing matters. Emergency contraception is most effective when taken as close in time to unprotected intercourse. Medication abortion is safest and most likely to be successful when people take the approved FDA regimen of mifepristone and mifepristone between 5 weeks and 0 days and 10 weeks of pregnancy.

Some critics of advance provision of emergency contraception worried that people might engage in riskier behavior if they knew they had a “back-up plan.” This has not shown to be true. Researchers report that advance provision of emergency contraception did not increase rates of sexually transmitted infections, unprotected intercourse, or changes in contraceptive methods. Women who received emergency contraception in advance were just as likely to use condoms as other women. While not yet studied, it is unlikely that people would take greater risks in terms of unprotected intercourse with the advance provision of medication abortion pills.

Advance Provision is What People Want

A growing number of people in the United States want access to abortion medications before they are even pregnant. Even before the pandemic, we learned that medication abortion provided through clinic-based telemedicine is effective and acceptable to patients. The COVID pandemic showed us that more people want to access abortion medications online and that it can be done safely.

Often when people decide to have an abortion, they want it done early in the pregnancy. Researchers reported that in 2019 most abortions (79.3%) were performed at less than 9 weeks’ gestation, and nearly all (92.7%) were performed at ≤13 weeks’ gestation. Another survey found of those seeking medication abortion pills by mail 93% were at or under 10 weeks gestation.

Other key factors in people’s decisions to choose a medication abortion in their own home were convenience, comfort, and privacy. If legal restrictions and the criminalization of abortion continue to increase, advance provision may also be a more secure option for people fearing legal ramifications or social judgement for their choice.

Advance Provision & Choix – Comprehensive Medical Abortion Care When and Where You Need it Most

Multiple studies, examples from other countries, and data collected during the pandemic all demonstrate that the advance provision of medication abortion is safe, effective, and what people want. Advance provision of medication abortion enables pregnant people to make informed health decisions and safely manage their pregnancy with or without the support of a health care provider. Giving people access to abortion pills before they are pregnant creates more time and flexibility for people deciding how, when, and if to choose abortion. The advance provision of medication abortion pills via telehealth providers like Choix, offers an empowering option at a time when options are limited for so many people.

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