Ordering abortion pills just in case

Study finds rise in the practice

Tens of thousands of women who are not pregnant are ordering abortion pills just in case they might need them someday, especially in states where access is threatened, according to a study published Tuesday.

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

In the study, published in the journal JAMA Internal Medicine, researchers evaluated data from Aid Access, a telehealth organization that has long provided abortion pills to women in the first 13 weeks of pregnancy and began offering the medication to women in the United States who weren’t pregnant in September 2021.

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

The biggest spikes in demand followed events that raised doubts about the future availability of abortion. Requests peaked in the weeks between the leak and the Supreme Court’s decision in June 2022 and in April 2023 after a flurry of court rulings in a lawsuit by opponents of abortion seeking to curtail the distribution of mifepristone, a key abortion pill, a case now before the Supreme Court.

Rates of requests were highest in states where abortion bans were expected — even higher than in states that already had bans. Asked why they requested the pills, most women said to “ensure personal health and choice” and “prepare for possible abortion restrictions,” according to the study.

“People were obviously paying attention and seeing the threat of abortion access either going away or being reduced where they were and thinking, ‘I need to get prepared for that,’” Aiken said.

Data from September 2021 through April 2023 showed 48,404 advance provision requests 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 provision requesters were more likely than those already pregnant to be 30 or older, white, and childless, and to live in urban neighborhoods with lower poverty rates than the national average. That might be partly because Aid Access offers free or reduced-price services to pregnant patients who need financial assistance, while advance provision requesters were expected to pay the full $110 cost, Aiken said.

And because few organizations offer advance provision, women from marginalized or lower-income communities might be less aware “that it’s even a thing you can do,” 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.

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