Online requests for abortion pills spiked after Roe was reversed: study

Telemedicine requests for abortion pills spiked dramatically after the Supreme Court overturned Roe v. Wade in June, according to new research released Tuesday.

The analysis, led by researchers at the University of Texas at Austin and published in the medical journal JAMA, analyzed requests made through Aid Access, a nonprofit telemedicine organization based in Austria that provides abortion pills for home use in states where the practice is restricted.

The study looked at requests for medications to the service starting in September 2021, before the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, through August 2022.

The findings show that putting limits on abortion within the formal health care setting did not eliminate it. People instead went outside the system, and self-managed abortions increased. 

“The increases indicate that while abortion bans create access barriers that lead to more people self-managing their abortions, self-managed abortion is also a method of choice for some,” said Abigail Aiken, lead author and an assistant professor at the University of Texas Austin’s LBJ School of Public Affairs.

During the initial period of the study from September 2021 to May 2022, when abortion was legal in every state, the organization received an average of about 83 requests a day. After the opinion draft was leaked, between May and June 23, daily requests increased to about 137. 

After the Supreme Court released its opinion on June 24 and some states immediately enacted abortion bans, the average daily requests jumped to nearly 214.

Every state, regardless of abortion policy, showed a higher request rate during the periods after the leak and after the formal decision announcement, with the largest increases observed in states enacting total bans, the study found. Requestors frequently cited those bans as their motivation for accessing the service.

But increases were also observed in states where the legal status of abortion did not immediately change. Researchers said that might be because of increased awareness about the option of ordering pills online, as well as confusion about the state of the law.

In states with total bans, the percentage of requestors who cited “current abortion restrictions” as a reason for using Aid Access doubled from 31 percent before the draft decision was leaked to 62 percent after the court’s ruling.

The largest increases per week from baseline to after the formal decision was announced came from five states: Louisiana, Mississippi, Oklahoma, Arkansas and Alabama.

Three of the states — Louisiana, Mississippi and Arkansas — are surrounded by other states that also ban abortion, which puts an added burden on traveling to the closest clinic.

The analysis excluded advance requests for abortion pills for people who were not already pregnant. Telemedicine abortion providers have started providing the pills before pregnancy in a bid to expand access to abortion.

Medication abortion has become an increasingly common method for ending pregnancies. According to the Guttmacher Institute, it accounted for 54 percent of all abortions in 2020. 

There are two pills needed for a medication abortion, which is approved by the Food and Drug Administration (FDA) for the first 10 weeks of pregnancy. Mifepristone, a drug that blocks hormones necessary for pregnancy, was approved in 2000. It is then followed by misoprostol, which causes contractions and helps empty the uterus.

The FDA temporarily lifted a requirement that mifepristone be dispensed in person at a clinic or hospital because of the COVID-19 pandemic, and the Biden administration made the change permanent in December 2021, paving the way for doctors to prescribe the drug digitally and then mail the pills to patients.

But 19 states, mostly in the south and midwest, currently ban providers from prescribing abortion pills through telemedicine. Aid Access is designed to skirt U.S. law by connecting patients with European doctors, who prescribe pills that are then mailed from India to U.S. pharmacies.