A study, published Monday in the medical journal JAMA, found that the number of pill abortions obtained outside the formal health system increased in the six months after the national right to abortion was overturned. Another report, released last week by the Guttmacher Institute, a research organization that supports abortion rights, found that medication abortions now account for nearly two-thirds of all abortions provided by the country’s official health system, which includes abortion telemedicine clinics and services.
The JAMA study evaluated data from overseas telemedicine organizations, online providers, and community volunteer networks receiving generic pills outside the United States. Before Roe was overturned, those streets provided abortion pills to about 1,400 women a month, but in the six months that followed, the average rose to 5,900 a month, the study said.
Overall, the study found that while abortions in the formal health care system fell by about 32,000 from July to December 2022, much of that decline was offset by about 26,000 medical pill abortions provided by sources outside the formal health system.
“We’re seeing what we’re seeing elsewhere in the world in the U.S. — that when anti-abortion laws come into effect, often outside the formal health care setting is where people look and the locus of care shifts,” said Dr. Abigail Aiken, who is an associate professor at the University of Texas at Austin and the lead author of the JAMA study.
The co-authors were professor of statistics at the university. the founder of Aid Access, a European-based organization that helped pioneer telemedicine abortion in the United States. and head of Plan C, an organization that provides consumer information about medication abortion. Before publication, the study went through the rigorous peer review process required by a major medical journal.
The telemedicine organizations in the study screened prospective patients using written medical questionnaires, issued prescriptions from doctors typically based in Europe, and had pills shipped from pharmacies in India, for a general fee of about $100. Community networks usually asked for some information about pregnancy and either delivered or mailed pills with detailed instructions, often free of charge.
Online sellers, who provided a small percentage of the pills in the study and charged between $39 and $470, generally did not ask for the women’s medical history and sent the pills with the least detailed instructions. The vendors in the study were audited by Plan C and found to be providing genuine abortion pills, said Dr. Aiken.
The Guttmacher report, which focuses on the formal health care system, included data from clinics and telemedicine abortion services in the United States that provided abortions to patients who lived in or traveled to states with legal abortions between January and December 2023.
It found that the pill accounted for 63 percent of those abortions, up from 53 percent in 2020. The total number of abortions in the report was over one million for the first time in more than a decade.
Because this matters
Overall, the new reports suggest how quickly abortion provision has adjusted amid post-abortion bans in 14 states and severe restrictions in others.
The numbers may be undercounted and do not reflect the most recent shifting laws: a shield in six states that allows abortion providers to prescribe and mail pills to tens of thousands of women in states with bans without requiring them to travel. Since last summer, for example, Aid Access has stopped sending medicine from abroad and operating outside the official health system. Instead, it ships pills to states with bans within the United States with the protection of shield laws.
What’s next
In the case to be heard before the Supreme Court on Tuesday, the anti-abortion plaintiffs are suing the Food and Drug Administration, seeking to block or drastically limit the availability of mifepristone, the first two-drug abortion pill. treatment.
The JAMA study suggests that such a decision could prompt more women to use avenues outside the formal American health care system, such as pills from other countries.
“There are so many unknowns about what will happen with the decision,” said Dr. Aiken.
He added: “It is possible that a High Court decision in favor of the claimants will have a negative effect when more people seek access outside of formal healthcare, either because they are concerned that access is being taken away or they have more trouble accessing medicines.”
