There was a staggering increase in requests for abortion pills through telemedicine in the months after the Supreme Court overturned Roe v. Wade, according to a new analysis.
The study, published Tuesday in JAMA, was conducted by researchers at the University of Texas at Austin and Aid Access, a nonprofit online telemedicine service that provides medication that people can use to safely end a pregnancy at home. They examined the organization’s data from September 2021 through August 2022 and saw two distinct spikes: the first, after the Supreme Court’s draft decision leaked to the public, and an even starker increase after the decision came down.
The largest increases in medication abortion requests came from states with the most severe restrictions, including Louisiana and Arkansas. But even in states unlikely to ban abortion, there was a noticeable increase.
“We want clinicians, patients, and the general public to understand that a shift in a legal environment to restrict one particular aspect of evidence-based health care does have far-reaching implications across health care broadly,” said Kirsten Bibbins-Domingo, the editor-in-chief of JAMA and the JAMA Network, who also penned an editorial in the journal on reproductive care access. “This group has already reported changes in self-managed abortions and how those have changed since the Dobbs decision, and gives us an early window into what patients will be doing in terms of one particular aspect of care.”
Since December 2021, the Food and Drug Administration has allowed providers to prescribe abortion pills — which are largely safe to take at home early in pregnancy — via telemedicine. Some state lawmakers have moved to restrict those prescriptions. But Aid Access, which is based in Austria, doesn’t operate within the U.S. health care system and has continued to provide the pills. To get the medication, patients fill out online forms that are reviewed by a medical team, which then sends prescriptions to pharmacies. Women living in states with more severe abortion restrictions have their prescriptions sent from India.
To conduct the study, the researchers looked at data from 30 states, and excluded advance requests for abortion pills for those who were not already pregnant. (Aid Access and other telemedicine abortion providers have started providing the pills before pregnancy in a bid to expand access to abortion — a practice that drew scrutiny this week from the Food and Drug Administration.)
Before the Dobbs decision leaked, Aid Access got about 83 requests each day on average, and that rate jumped to 214 requests a day after the Supreme Court issued its decision. About one-third of women in states with total abortion bans cited “current abortion restrictions” as their reason for requesting abortion pills before the leak. After, nearly two-thirds said state restrictions were why they’d reached out. The researchers saw a similar shift in states with six-week bans.
Even the looming threat of an abortion ban seemed to impact the volume of requests. In states where future bans are likely, 36% of residents making requests cited “possible future legal restrictions”after the decision. The authors found no statistically significant changes in the reasons the abortion pills were requested in states with no planned changes to abortion laws.
The study offers an early look at how the fast-changing legal landscape has impacted how people seek reproductive care.
“It’s an incredibly unique and invaluable dataset,” said Liza Fuentes, a senior research scientist at Guttmacher Institute, a research and policy organization which advocates for sexual and reproductive health and rights.
She noted that of the states with the largest increases in requests from female residents, three of the states — Louisiana, Mississippi, and Arkansas — “are surrounded on all sides by other states where abortion is banned.” This would place higher demands on residents seeking abortions who would have to travel even farther distances and have to consider possibly more time off of work, child care, and other factors that go into travel in addition to higher travel costs.
The other two states that saw the biggest increases — Alabama and Oklahoma — share borders with states that have complete abortion bans and neighbor other states with significant restrictions.
“In the places where people have the least chance — and in some cases, zero chance — of being able to get an abortion in their community, it makes sense that people would try to seek that care online,” Fuentes said. The authors speculated that increased awareness about telemedicine abortion access drove up requests from residents in states without restrictive abortion laws. But they also suspect confusion about the patchwork of state abortion laws may have had an effect.
“If people thought that abortion was restricted or illegal even if in their state, it stayed the same, they might have been more likely to request medications from Aid Access,” said Fuentes. Another potential factor: longer wait times for patients in states that haven’t restricted abortion access, as out-of-state patients traveling there for care put a strain on existing resources.
“The unequal and unjust impact that this decision had is really visible through this data,” said Rebecca Gomperts, a Dutch doctor and the founder and director of Aid Access. “It’s very important that this becomes visible and also to make the American public, doctors, [and] politicians understand that this is unequally affecting people without financial means and people that are living at the poverty level.”
This finding of an overall increase in requests for abortion medication comes at the same time as another abortion count, which found a drop in legal abortions nationwide by 6% and accounted for more than 10,000 fewer people who had abortions in July and August following the Dobbs decision. Comparing April and August 2022, there was a 33% increase in virtual-only services.
To experts, the data are a clear early sign that the changing abortion laws have not changed the stark reality that people need abortion care — they have just impacted access and how people seek it. As more abortions are pushed outside traditional health care settings, it’s important to be able to see how people most affected by these laws are receiving care safely and to know where to meet them.