Telehealth Abortion Is Still Possible Without Mifepristone
Telehealth Abortion Is Still Possible Without Mifepristone
即使没有米非司酮，远程医疗堕胎依然可行
Abortion provider Carafem’s phones were ringing nonstop over the weekend after a US federal appeals court reinstated a nationwide requirement that the drug mifepristone, one of two pills used for a medication abortion, must be obtained in person. The decision, handed down on Friday, left patients unsure if they could gain access to their treatment through telehealth. “People are afraid, and they’re angry,” says Carafem’s chief operations officer, Melissa Grant. “I had people contact us saying, This can’t be true. Do you still have the medication available? Can’t you just give it to me? They were bargaining.”
上周末，美国一家联邦上诉法院恢复了全国性要求，规定药物流产所需的两种药片之一——米非司酮（mifepristone）必须当面获取。此消息一出，堕胎服务机构 Carafem 的电话响个不停。周五作出的这项裁决让患者们感到困惑，不确定是否还能通过远程医疗获得治疗。“人们感到恐惧和愤怒，”Carafem 的首席运营官梅丽莎·格兰特（Melissa Grant）说，“有人联系我们说：‘这不可能是真的。你们还有药吗？不能直接给我吗？’他们在试图讨价还价。”
With the restriction in place, Carafem quickly pivoted to a backup approach. Instead of prescribing the two-drug protocol typical for a medication abortion—mifepristone, which blocks progesterone and prevents the pregnancy from progressing, and then misoprostol, which causes the uterus to contract—the organization began prescribing misoprostol on its own. While slightly less effective than the dual-pill option, it’s been widely used in the past. “We feel comfortable prescribing it,” says Grant.
随着限制措施的实施，Carafem 迅速转向了备用方案。他们不再开具药物流产通常采用的两种药物方案（即先服用阻断孕酮以阻止妊娠发展的米非司酮，再服用引起子宫收缩的米索前列醇），而是开始单独开具米索前列醇（misoprostol）。虽然其效果略逊于双药方案，但它在过去已被广泛使用。“我们对开具这种药物感到放心，”格兰特说。
Some Planned Parenthood clinics also pivoted to the misoprostol-only regimen this weekend. “Planned Parenthood providers are doing everything they can to make sure patients know that medication abortion is still safe, legal, and available,” says Danika Severino, vice president of care and access at Planned Parenthood Federation of America.
一些计划生育协会（Planned Parenthood）的诊所本周末也转向了仅使用米索前列醇的方案。“计划生育协会的医疗服务提供者正在尽一切努力，确保患者知道药物流产仍然是安全、合法且可获得的，”美国计划生育协会护理与获取副总裁达妮卡·塞韦里诺（Danika Severino）表示。
On Monday, the Supreme Court offered a temporary reprieve, pausing the appeals court ruling for a week. The measure allows patients to once again get mifepristone through virtual clinics at least until May 11, when SCOTUS will take another look at the case. Carafem and Planned Parenthood say they are prepared to shift back to misoprostol-only if necessary. Other providers, including the digital abortion clinic HeyJane, have confirmed that they will also take that approach if necessary.
周一，最高法院提供了一项临时缓刑，将上诉法院的裁决暂停了一周。该措施允许患者至少在 5 月 11 日最高法院重新审理此案之前，再次通过虚拟诊所获得米非司酮。Carafem 和计划生育协会表示，如有必要，他们已准备好转回仅使用米索前列醇的方案。包括数字堕胎诊所 HeyJane 在内的其他服务提供商也已确认，必要时他们也会采取这种方法。
Mifepristone was developed in the 1980s in France and has been extensively studied for safety and efficacy. It was approved by the Food and Drug Administration in 2000. Under President Joseph Biden, the FDA first allowed the drug to be obtained by mail instead of in person in April 2021, during the Covid-19 pandemic. The agency permanently lifted the in-person dispensing requirement in 2023.
米非司酮于 20 世纪 80 年代在法国开发，其安全性和有效性已得到广泛研究。它于 2000 年获得美国食品药品监督管理局（FDA）批准。在乔·拜登总统任期内，FDA 于 2021 年 4 月新冠疫情期间首次允许通过邮寄而非当面获取该药物。该机构于 2023 年永久取消了当面配药的要求。
After the Supreme Court overturned Roe v. Wade in 2022, ending the constitutional right to an abortion, medication abortion via telehealth became a more sought-after option, especially for patients in states that adopted abortion restrictions. Approximately one in three abortions that took place in the first half of 2025 used abortion pills obtained through telehealth, according to public health nonprofit Plan C.
2022 年最高法院推翻“罗诉韦德案”（Roe v. Wade）、终结了宪法赋予的堕胎权后，通过远程医疗进行药物流产成为更受欢迎的选择，尤其是在那些采取了堕胎限制措施的州的患者中。据公共卫生非营利组织 Plan C 称，2025 年上半年进行的堕胎手术中，约有三分之一使用了通过远程医疗获得的堕胎药。
Access to mifepristone has become the next major battleground in reproductive health, with anti-abortion politicians and lobbyists seeking to reinstate in-person dispensing requirements on the drug and, by doing so, make medication abortion harder to obtain.
米非司酮的获取已成为生殖健康领域的下一个主要战场，反堕胎政客和游说团体正寻求恢复对该药物的当面配药要求，从而使药物流产变得更难实现。
After conflicting legal rulings in 2023 sparked confusion over whether mifepristone would be available from virtual clinics, some of them planned to temporarily shift to offering misoprostol-only medication abortions. Some virtual clinics have offered single-pill options even before that. Carafem offered misoprostol-only medication abortions beginning in 2020, in an effort to provide patients with options for virtual care during the early days of Covid.
2023 年，相互矛盾的法律裁决引发了关于虚拟诊所是否能提供米非司酮的困惑，一些诊所计划暂时转向仅提供米索前列醇的药物流产。在此之前，一些虚拟诊所就已经提供单药方案。Carafem 从 2020 年开始提供仅使用米索前列醇的药物流产，旨在为新冠疫情初期的患者提供远程护理选择。
Originally developed to treat gastric ulcers, misoprostol has been used for medication abortion since the late 1980s. It remains the primary method of medication abortion in many parts of the world where access to mifepristone is limited.
米索前列醇最初是为治疗胃溃疡而开发的，自 20 世纪 80 年代末以来一直被用于药物流产。在世界上许多米非司酮获取受限的地区，它仍然是药物流产的主要方法。
“Mifepristone and misoprostol are both very safe medications, and in general, having mifepristone increases the efficacy and decreases complication rates of medication abortion,” says Rachel Jensen, a fellow with the American College of Obstetricians and Gynecologists, which endorses the misoprostol-only protocol when mifepristone isn’t available. The single-drug regimen is also endorsed by the World Health Organization, the Society of Family Planning, and the National Abortion Federation.
“米非司酮和米索前列醇都是非常安全的药物。总的来说，使用米非司酮可以提高药物流产的有效性并降低并发症发生率，”美国妇产科医师学会（ACOG）的研究员瑞秋·詹森（Rachel Jensen）说。该学会支持在无法获得米非司酮时使用仅含米索前列醇的方案。这种单药方案也得到了世界卫生组织、家庭计划协会和全国堕胎联合会的支持。
“Before mifepristone became available, misoprostol was the only medication that was used for medication abortion. So we know that it’s also safe and effective,” Jensen says. “It’s just a little bit less effective than the combined regimen.”
“在米非司酮问世之前，米索前列醇是唯一用于药物流产的药物。所以我们知道它也是安全有效的，”詹森说，“只是比联合用药方案的效果稍差一点。”
Most people only need one dose of misoprostol when using mifepristone, as opposed to three or more doses when using just misoprostol. The medication can cause nausea, vomiting, and uterine cramping, and using it alone can cause more intense or prolonged side effects since more doses are needed. Jensen recommends that patients have anti-nausea and pain medication on hand to manage side effects.
大多数人在使用米非司酮时只需要一剂米索前列醇，而仅使用米索前列醇时则需要三剂或更多。该药物可能引起恶心、呕吐和子宫痉挛，由于需要更多剂量，单独使用可能会导致更强烈或更持久的副作用。詹森建议患者准备好止吐药和止痛药，以应对副作用。
Abortion providers that decide to continue allowing patients to get mifepristone through virtual appointments may face civil repercussions if the Supreme Court sides with the appeals court. There is a chance that the FDA may decide to use enforcement discretion not to pursue health care professionals who continue to offer it.
如果最高法院支持上诉法院的裁决，决定继续允许患者通过虚拟预约获取米非司酮的堕胎服务提供者可能会面临民事后果。FDA 有可能决定行使执法自由裁量权，不对继续提供该药物的医疗专业人员进行追究。
“This FDA has become both incredibly politicized, but at the same time, we’ve also seen it stick aligned to the science,” says human rights lawyer Julie F. Kay. “So it’s very hard to tell what the FDA will do.” The FDA did not respond to a request for comment.
“现在的 FDA 变得极其政治化，但与此同时，我们也看到它坚持以科学为准绳，”人权律师朱莉·F·凯（Julie F. Kay）说，“所以很难判断 FDA 会怎么做。”FDA 未回应置评请求。
Even if the courts allow remote mifepristone prescribing to resume, other challenges await. Anti-abortion activists are also trying to restrict mifepristone access through legislation. This year, Republican senator Josh Hawley introduced a bill banning the medication.
即使法院允许恢复远程开具米非司酮，其他挑战依然存在。反堕胎活动人士也试图通过立法限制米非司酮的获取。今年，共和党参议员乔什·霍利（Josh Hawley）提出了一项禁止该药物的法案。
Despite the wave of challenges, reproductive health care activists are determined to keep providing care. “Abortion will proceed no matter what,” Plan C director Elisa Wells says. Even if domestic virtual clinics run into challenges, Wells says that alternative routes for the…
尽管面临重重挑战，生殖健康护理活动人士仍决心继续提供服务。“无论如何，堕胎服务都会继续，”Plan C 主任埃莉萨·威尔斯（Elisa Wells）说。威尔斯表示，即使国内的虚拟诊所遇到挑战，其他替代途径也依然存在……