Abortion pill doses rose after Roe fell
Study: Increase nearly offsets decline in surgical procedures
The number of women using abortion pills to end their pregnancies on their own without the direct involvement of a U.S.-based medical provider rose sharply in the months after the Supreme Court eliminated a constitutional right to abortion, according to the most comprehensive examination to date of how many people have ended their pregnancies outside of the formal medical system since the ruling.
Nearly 28,000 additional doses of pills intended for “self-managed” abortions were provided in the six months after the fall of Roe v. Wade — more than quadrupling the average number of abortion pills provided that way per month before the decision and suggesting many women have turned to medication abortion to circumvent state bans.
The research — published in JAMA on Monday, the day before the highly anticipated Supreme Court arguments on a challenge to a key abortion drug — highlights the importance of abortion pills in post-Roe America.
Before the ruling legalized abortion nationwide in 1973, women seeking abortions were forced to find someone to perform an illegal surgical procedure, leading to thousands of deaths.
Today, the process for accessing abortion is far easier and safer, with a rapidly expanding online and community-based network of pill suppliers sending pills through the mail into states with strict bans.
Other studies have estimated approximately 32,000 fewer abortions occurred at licensed brick-and-mortar and telehealth clinics in the six months following the fall of Roe. But the jump in self-managed abortions offsets nearly that whole figure.
“The numbers we’re looking at seem to suggest that [self-managed abortion] is more mainstream than perhaps we thought,” said Abigail Aiken, a professor at the University of Texas at Austin and the lead author of the study. “This is something people are doing on a larger scale.”
Women in states with bans are also using the traditional health care system to access abortion, traveling out of state to pick up pills or to have a procedure at a clinic in a state where abortion remains legal.
A different study published last week by the Guttmacher Institute, which supports abortion rights, revealed the overall number of abortions facilitated within the formal health care system increased last year despite the bans, with medication abortions accounting for 63% of the more than 1 million abortions performed in 2023.
Taken together, the new data shows while the ruling has made abortion more difficult to access for people in antiabortion states, a large portion of those women have been able to navigate around the laws and end their pregnancies.
Self-managed abortions with pills are facilitated in a legal gray area. Women obtaining abortions by mail are not breaking the law themselves; abortion bans are designed to penalize doctors and others involved in facilitating an abortion. Those involved with distributing the pills could be charged. In many states, abortion bans carry penalties of at least several years in prison.
The landscape of self-managed abortion is sprawling and difficult to quantify, Aiken said. According to Plan C, an abortion rights organization that tests pills and publishes a list of verified sources online, at least 25 websites now mail abortion medication into states that ban the procedure.