More and more women who are not pregnant are ordering abortion pills just in case

Why it matters

The practice, known as advance dispensation, is relatively new and has increased significantly since the Supreme Court’s 2022 decision to overturn the nation’s right to abortion.

In the study, published in the journal JAMA Internal Medicine, researchers evaluated data from Aid Access, a telehealth organization that had long provided abortion pills to women in the first thirteen weeks of pregnancy and began offering the medication to women in the United States which were. not pregnant in September 2021.

Before May 2022, when a draft of the High Court decision was leaked, Aid Access had received around 6,000 requests for advance payments, an average of 25 per day. Since then, it has received more than 42,000 requests, an average of 118 per day, said Dr. Abigail Aiken, an associate professor at the University of Texas at Austin and co-author of the study.

The biggest spikes in demand followed events that cast doubt on the future availability of abortion. The number of requests peaked in the weeks between the leak and the Supreme Court’s decision in June 2022, and in April 2023 after a series of court decisions in a lawsuit by abortion opponents seeking to restrict mifepristone, a major abortion pill, a case which is now before the Supreme Court. .

The number of requests was highest in states where abortion bans were expected – even higher than in states where bans already existed. When asked why they requested the pills, most women said they would “ensure personal health and choice” and “prepare for possible abortion restrictions,” the survey said.

“People were clearly paying attention and saw the threat of abortion access disappearing or shrinking where they were, and thought, ‘I need to prepare for that,’” said Dr. Aiken.

Behind the numbers

Data from September 2021 through April 2023 showed 48,404 requests for advance payments and 147,112 requests from women seeking to terminate existing pregnancies. (Women in both categories completed telehealth consultations and Aid Access evaluated their medical information before prescribing pills.)

Advance applicants were more likely than those who were already pregnant to be 30 years or older, white and childless, and to live in urban neighborhoods with lower poverty rates than the national average. That may be partly because Aid Access offers free or reduced-price services to pregnant patients needing financial assistance, while advance applicants were expected to pay the full $110 cost, said Dr. Aiken.

And because few organizations provide upfront services, women from marginalized or lower-income communities may be less aware “that it’s something you can do at all,” she said.

Medication abortion typically involves two pills: mifepristone, which has a shelf life of three to five years, followed a day or two later by misoprostol, which has a shelf life of 18 to 24 months.

Dr. Aiken said a portion of the advance applicants — 937 women, two-thirds of them in states with abortion bans or restrictions — answered follow-up questions. Most still had the pills, but 58 had taken them and 55 had given them to someone else.

About 60 percent took the pills before seven weeks of pregnancy, early in the recommended period. A large majority indicated that they had sufficient information, including about expected bleeding and cramps. All 58 said the pills worked. Five subsequently visited healthcare providers, but none went to hospital or suffered serious complications.

Bigger implications

Legal scholars say providing advance abortions may be legal in some states with abortion bans. “Many state abortion laws require a provider to know that a person is pregnant,” three law professors – David S. Cohen, Greer Donley and Rachel Rebouché – wrote in an article to be published in the Stanford Law Review. However, they added that in some states, abortion providers may be legally vulnerable because they know “the pills are being prescribed to terminate a future pregnancy.”

Opponents of abortion object to pre-dispensing abortion medications, claiming that abortion medications are dangerous. Abortion rights advocates say prescribing them for future needs, such as antibiotics for traveler’s diarrhea, increases access and underlines that the pills are safe, as many studies show.