The enforcement gap

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NICK EICHER, HOST: Up next on The World and Everything in It, pro-lifers and lawmakers sound the alarm over online abortion-drug providers.

MARY REICHARD, HOST: Black market abortion pills are nothing new. But since the Supreme Court’s Dobbs decision, pro-life advocates say more websites are offering to ship the drugs to women. And they’re not adhering to the few remaining protections.

Now, members of Congress are calling on the Trump administration to crack down on the illegal pills. Here’s WORLD’s Lauren Canterberry.

LAUREN CANTERBERRY: Heather Lawless is no stranger to buying abortion pills online. Last year, she spoke to someone on the Signal app who said they could help her do just that.

LAWLESS: I said I need them sent to me. I’m in Idaho, is that allowed?

Idaho protects nearly all women and babies from abortion and abortion drugs. But the anonymous stranger on the other end of the Signal chat replied.

LAWLESS: Yes, you can take abortion pills in the state of Idaho. Email this email and they’ll send you the abortion pills for free.

Lawless wasn’t pregnant, and the drugs were not for her–or anyone else. She’s the founder and CEO of the pro-life Reliance Ministries and she says she and her team have seen the number of black market abortion pill sites skyrocket since the 2022 Dobbs v. Jackson Women’s Health Organization Supreme Court decision.

The U.S. Food and Drug Administration does not recommend buying abortion drugs online, and has only approved mifepristone for use in at-home abortions through 10 weeks.

But on Signal, the user went ahead with telling Lawless how to get the pills, even when she said she was 12 weeks pregnant.

LAWLESS: I filled out the form and then they sent me an email and they sent me a protocol for 11 to 16 weeks.

The abortion drugs Lawless has received come in packaging different from the manufacturers’, usually with little to no instructions or information about risks and side effects.

LAWLESS: They come in these little black baggies that like heroin would come in or fentanyl would come in.

The Senate Committee on Health, Education, Labor, and Pensions has taken notice of the same problems Lawless has found: that many abortion drug suppliers that market to American women do not comply with the U.S. government’s requirements.

In March, it asked the FDA and mifepristone makers to combat the online sale of unapproved and misbranded abortion drugs. But they missed the committee’s deadline last week to respond to questions about how they regulate abortion pills.

Dr. Ingrid Skop is the vice president and director of medical affairs for the Charlotte Lozier Institute.

SKOP: Abortion has been able to follow its own rules outside of the normal way that medicine is practiced.

In 2011, the FDA recognized mifepristone posed serious health risks, and so it implemented a REMS. a Risk Evaluation and Mitigation Strategy program to ensure it was prescribed correctly and to track adverse outcomes. But the agency has since expanded the drug’s use from 7 weeks of pregnancy to 10 and removed key protections—like the in-person dispensing requirement.

SKOP: It continues to require the prescriber to accurately assess the gestational age, to rule out ectopic pregnancy, and to be available if a woman has a complication that requires surgery.

But Skop said since many women and girls order the drugs without ever speaking to a doctor or even visiting a pharmacy these requirements are nearly impossible to follow.

SKOP: You don’t have to look very far to discover that abortion drug prescribers are not following the REMS.

The FDA also requires the three approved mifepristone manufacturers to decertify prescribers who don’t follow the REMS plan. Something they have NOT been doing.

According to the Senate HELP Committee’s letters, all three direct women to third-party websites which openly advertise the drug for use after the 10th week of pregnancy. The senators argue that the companies appear to be promoting prescribers who are not following regulations. And they say the FDA has not done enough on their end either.

SKOP: I think it is absolutely critical that the FDA police its own prescribers. Their job is to serve the American public. Their job is to protect women and girls from dangerous drugs.

During the first Trump administration, some effort was made to hold illegal sellers of abortion pills accountable, though with little success. Now in Trump’s second term, pro-lifers say there’ve been even fewer attempts.

Many pro-lifers say the best move would be to reinstate the in-person dispensing requirement for abortion drugs that was in place during Trump’s first term.

Jamie Dangers is the director of federal affairs for Susan B. Anthony Pro-Life America.

DANGERS: The pipeline now is so wild west and so there's, there's no way of protecting women.

She says requiring women to obtain abortion drugs from a prescriber in-person is an obvious way to protect them from the dangers of chemical abortions.

DANGERS: This letter, I think, really lays out how low the bar is right now.

But even if the administration does not reinstate the dispensing requirement, Danger said holding abortion drug sellers accountable for failing to follow the REMS plan would still be a good step. Whether the FDA will do so, remains to be seen.

Reporting for WORLD, I’m Lauren Canterberry.

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