By Anuja Vaidya
Advance ordering of abortion medications via telehealth peaked after the leak of the Supreme Court ruling against the constitutional right to abortion, new research shows.
Published in JAMA Internal Medicine, the research letter aimed to examine trends in the demand for advance provision of abortion medications after the leak of the Supreme Court decision, as well as the characteristics and motivations of those requesting advance provision.
Advance provision of abortion medications refers to receiving prescriptions of mifepristone and misoprostol before pregnancy occurs. Prior research shows that a majority of women who were not pregnant or planning pregnancy were interested in the advance provision of abortion drugs even before the leak.
The leak of the Supreme Court decision in the case of Dobbs v. Jackson Women’s Health Organization was followed by the official release of the decision in June 2022. The decision overturned Roe v. Wade, eliminating the constitutional right to abortion nationwide and leaving it up to individual states to decide abortion laws.
For the study, researchers from the University of Texas at Austin, Mathematica Inc., Vrije Universiteit in Amsterdam, and telehealth provider Aid Access examined requests for advance provision of abortion medications following the leak of the decision. The researchers studied data from Aid Access, which has offered advance provision of abortion medications since September 2021.
The study included residents of all 50 states and Washington, DC, who requested advance provision across four periods: baseline (September 1, 2021, to May 1, 2022); after the Dobbs decision was publicly leaked (May 2 to June 23, 2022); after the Dobbs decision was formally announced (June 24, 2022, to April 6, 2023); and during conflicting judicial rulings on Food and Drug Administration approval for mifepristone (April 7 to April 30, 2023).
The researchers compared mean weekly request rates per 100,000 female residents aged 15 to 44 in each state across all four periods. They also gathered data on requestors’ demographic characteristics, including age, self-reported racial and ethnic identity, number of children, rural versus urban residence, and regional poverty level. They compared that data with those requesting medications for a current self-managed abortion, that is, requests for abortion medication among those who were pregnant.
Between September 1, 2021, and April 30, 2023, Aid Access received 48,404 advance provision requests. The mean number of daily requests was 24.8 during baseline, 247.3 after the Dobbs leak, 89.1 after the formal Dobbs decision, and 172.1 after opposing rulings regarding FDA mifepristone approval. The mean weekly rate of requests increased from 0.4 to 3.5 per 100,000 women in states where an abortion ban was highly likely.
The study shows that a higher proportion of those requesting advance provision were 30 years or older (34 per cent) compared with those requesting medication for self-managed abortion (27 per cent), and 67 per cent of the former self-identified as White versus 39 per cent of the latter.
Additionally, most people requesting advance provision had no children, lived in an urban region, and lived in an area with a poverty rate less than the national average compared with those requesting medications for self-managed abortion.
“The demographic differences in requestors of advance provision vs self-management likely reflect structural barriers,” the researchers wrote.
They also noted that the most common reasons for requesting advance provision were to ensure personal health and choice (74 per cent) and to prepare for potential abortion restrictions (73 per cent).
Telehealth has become a vital tool in ensuring abortion access amid growing restrictions nationwide.
A report from the Society of Family Planning shows that abortions provided by virtual-only clinics accounted for nearly 5 per cent of all abortions before the Dobbs decision, growing to greater than 8 per cent of all abortions in the 12 months after the decision.
Further, a study published last September shows that individuals who self-reported as multiracial or “other race” were 4.5 times more likely to use telehealth medication abortion services (tele-MAB) compared with White individuals. The study analyzed EMR data from 1,241 individuals receiving telehealth and in-person abortion services at a reproductive healthcare clinic in Washington state between April 23, 2020, and January 31, 2022.
The study also revealed that those with at least one health condition, as well as younger individuals and non-English speakers, were less likely to receive tele-MAB compared with in-clinic care.
