Mailing Abortion Pills Does Not Delay Care: A Cohort Study Comparing Mailed to In-Person Dispensing of Abortion Medications in the United States

Contraception; 2023 Feb 1; Vol. 121; 109962. doi:10.1016/j.contraception.2023.109962

Objective: Given the substantial barriers to abortion access in the US, many clinics now mail patients abortion medications. We examined whether dispensing the medications by mail prolonged time to medication use.

Methods: We analyzed data from no-test medication abortions with medication provided either by mail or in a clinic from 11 US clinics from February 2020 to January 2021. We examined: mean number of days from patients' first contact with the clinic to mifepristone ingestion; its two component intervals (first contact to medication dispensing and dispensing to mifepristone ingestion); and pregnancy duration at mifepristone ingestion. We used Poisson regression to compare mean outcomes across three dispensing methods: in person, mailed from the clinic, and mailed from a mail-order pharmacy.

Results: Among the 2,600 records, patients took mifepristone on average at 49 days of gestation (95% CI: 47-51) and seven days (95% CI: 4-10) after first contact. Mean time from first contact to mifepristone ingestion was six days when medications were dispensed in person and nine days when mailed (p=0.38). While time from first contact to dispensing was similar across methods (six days in person, five days mailed, p=0.77), more time elapsed from dispensing to mifepristone ingestion when medications were mailed (four days from clinic, five days from mail-order pharmacy) vs. dispensed in person (0.3 days, p<0.001). Time to mifepristone ingestion was shorter with higher pregnancy duration. Pregnancy duration at ingestion was similar across methods (48 days in-person, 50 days mailed).

Conclusions: Mailing medications did not significantly prolong time from patients' first contact with the clinic to mifepristone ingestion or increase pregnancy duration at mifepristone ingestion.

Keywords: Risk Evaluation and Mitigation Strategy (REMS); mailing; medication abortion; mifepristone; pharmacy; telehealth.