Online clinic offering abortion pills to patients who aren’t pregnant for future use

An online clinic is offering abortion pills to patients who aren’t pregnant in Illinois and several other states, allowing the medication to be kept on hand for future use.

Choix, a California-based reproductive health care startup, launched the service Wednesday to increase access to abortion, particularly after the U.S. Supreme Court overturned Roe v. Wade in June, ending federal abortion protections.

While medication abortions are relatively common, accounting for more than half of all terminated pregnancies in the United States, providing the pills to patients who haven’t even conceived is a new frontier in the reproductive rights landscape.

“Everyone should be able to access supportive, nonjudgmental and trusted abortion,” Choix CEO and nurse practitioner Cindy Adam said in a news release. “Unfortunately, we know that isn’t the case for the countless people who increasingly face barriers to accessing abortion care in the U.S.”

The service, which the company calls “advance provision,” is also available in California, New Mexico, Colorado and Maine.

In Illinois, patients must be 15 or older to access the service, according to the Choix’s website.

“We believe in the power of planning ahead and being prepared for the unexpected,” the website says. “Advance provision is a way for people to get abortion pills ahead of time in case they need them in the future.”

Patients fill out a questionnaire online, which includes questions about their medical history. Questionnaires are reviewed within 48 hours by the clinic’s health care practitioners; a medical provider will then text message the patient to confirm information and send consent forms, the website says.

“Prior to approving a patient for advance provision of abortion pills, Choix reviews the patient’s health questionnaire in order to confirm that the abortion medications would be safe for the patient to use based on their medical history,” Adam said in an email.

If a patient becomes pregnant in the future and decides to use the abortion pills, “we ask that they return to Choix for medical support and guidance throughout their abortion process,” Adam said.

Once the patient returns and completes a new medical intake, a clinician will evaluate the patient’s information to ensure sure it’s still safe to take the medications, she said.

She added that health care providers review medical information such as the patient’s last menstrual period, any bleeding or other irregular symptoms, as well as indications that an ultrasound might be needed.

“Telehealth in general is built on mutual trust within the patient-provider relationship, and it’s core to our approach to care at Choix,” Adam said. “We trust that our patients know their bodies and health histories, and want the best outcomes for themselves.”

The medication costs between $175 and $350, which includes shipping. The pills are delivered in two to four business days, but can be expedited for a $25 fee, according to the website.

Choix, an online sexual and reproductive health clinic based in the San Francisco Bay Area, began offering medication abortions in 2020. The clinic’s health care providers include physicians and other clinicians.

Eric Scheidler, executive director of the Chicago-based Pro-Life Action League, called the service “a cynical marketing ploy to get women to effectively choose abortion before they’re even pregnant.”

“The American medical community is so drunk on abortion that now they want to sell abortion pills to women who aren’t even pregnant, without regard for the risks involved in providing a treatment without any in-person consultation, and without regard to changes in medical history between the time of dispensing and use,” he said. “Moreover, this proposal betrays blood-chilling hostility to unborn children — as if pregnancy itself were a deadly medical condition.”

Medication abortions have been approved for use in early pregnancy since 2000 in the United States.

The process consists of a two-drug regimen: First the patient takes mifepristone, which blocks the hormone progesterone to stop the pregnancy from growing. A day or two later the patient takes the second pill, misoprostol, which causes the uterus to contract and the cervix to open slightly, expelling the pregnancy.

Until recently, the U.S. Food and Drug Administration required that clinicians dispense the first medication, mifepristone, in person at a medical facility, health care office or hospital. The second pill, misoprostol, could be taken by the patient at home.

In a historic shift, the FDA in December rolled back those regulations, allowing mifepristone to be mailed directly to a patient, eliminating the need to leave home or visit a bricks-and-mortar clinic to terminate a pregnancy.

This allows patients in some states, including Illinois, to first get a prescription through a telehealth visit and have the pills shipped directly to them. Mail-order services, however, are prohibited in many states due to prohibitions on medication abortion use or telehealth services for abortion, as well as other restrictions on terminating a pregnancy.

The FDA’s policy change was praised by reproductive rights advocates but decried by abortion opponents, who argued in part that the decision would compromise the safety of pregnant patients.

“Every life is sacred: the lives of mothers and the lives of the unborn,” said Archbishop William Lori of Baltimore, chairman of the U.S. Conference of Catholic Bishops’ Committee on Pro-Life Activities, in a statement. “Not only does this decision further the tragic taking of unborn lives but it does little to care for the well-being of women in need. Far from the accompaniment that women in crisis pregnancies deserve, this decision would leave women alone in the midst of trauma, often without any medical attention or follow up care.”

Planned Parenthood of Illinois in April began offering abortion pill-by-mail services to in-state residents who are 10 weeks pregnant or less. The patient first has a telehealth visit with a medical provider and must be physically in Illinois during that appointment, according to the agency. Then the medication is shipped to an Illinois address.

“Medications will be shipped in discrete packaging to your Illinois address, and will arrive within two business days of your telehealth appointment,” Planned Parenthood of Illinois says on its website.

Out-of-state patients must travel to Illinois for their telehealth visit then pick up the medication at an Illinois clinic, according to the agency.

Many states restrict the use of abortion pills or outright ban telehealth services to terminate a pregnancy.

Nineteen states require a medical provider be physically present when a medication abortion is administered, prohibiting the use of telemedicine, according to a report by the Guttmacher Institute, a research group that supports reproductive rights.

In 2022, more than 100 restrictions were introduced in 22 states, including seven provisions that would entirely ban medication abortion, according to the Guttmacher report. Some of the other measures would specifically prohibit mailing abortion pills or require physicians to provide medication abortions, as opposed to allowing other clinicians such as advanced practice nurses or physician assistants to do so.

It’s unclear, however, how states will enforce these regulations, since numerous websites and providers in other countries offer the medications online, sometimes without a prescription or medical information.

Medication abortions accounted for 54% of all terminations in the United States in 2020, according to the Guttmacher Institute.

“However, medication abortion has become a primary target of anti-abortion politicians and activists seeking to restrict care in and out of clinical settings,” the report said. “Anti-abortion state policymakers have shown they are focused on further restricting access to medication abortion this year.”

eleventis@chicagotribune.com