Uncertainty around US abortion landscape drives surge in requests to stockpile abortion medication, research shows

By Deidre McPhillips, CNN

(CNN) — Amid significant upheaval to the abortion landscape in the United States, thousands of women have preemptively requested medication abortion pills in case they need them in the future, new research shows.

Aid Access, a nonprofit telehealth service, provides medication abortion by mail. The organization has offered “advance provision” of those drugs, mifepristone and misoprostol, for more than two years – and demand has surged over the past year and a half since the leak of the US Supreme Court’s Dobbs decision that overturned Roe v. Wade.

In the first eight months that Aid Access offered advance provision of medication abortion – from September 2021 through April 2022 – it received an average of 25 orders a day, according to research published Tuesday in the journal JAMA Internal Medicine. But in the two months after the Dobbs decision was leaked, from May 2022 to late June 2022, daily requests spiked nearly tenfold to about 247 orders a day.

Requests slowed for a while after the Dobbs decision was formally released, with an average of 89 orders per day from late June 2022 through early April 2023. But demand spiked again as conflicting legal rulings created uncertainty around approval for mifepristone, with more than 170 requests per day through the end of April.

Dr. Abigail Aiken, an associate professor of public affairs at the University of Texas at Austin, who led the research, says the study shows that “it’s the potential policy shocks that people are reacting to. … It’s the idea that people are paying attention and getting out ahead of things.”

“What we’re seeing there really is a response to the fear and the uncertainty and feelings of, I guess, helplessness that the Dobbs decision brought for people,” Aiken said. “When the leak happened, I think the writing was on the wall and people thought, ‘I need to get out ahead of this.’”

Overall, Aid Access has received more than 48,000 orders for advance provision of medication abortion, according to the new research. About three-quarters of people who requested it said that they wanted to “ensure personal health and choice” or “prepare for possible abortion restrictions.”

“States considering future abortion bans had the highest rates of requests, and requestors were motivated by a desire to preserve reproductive autonomy,” the researchers wrote.

Compared with those requesting medication abortion to end an existing pregnancy, people requesting advance provision of medication abortion were more likely to be wealthier, White, age 30 or older and not have other children. These differences probably reflect structural barriers, the researchers wrote.

The structural barriers that could have influenced who was more likely to order medication abortion pills in advance include their cost and access to information about them, Aiken said. The service can cost more than $100, although Aid Access offers a sliding scale for those who need it, and people with fewer means are less likely to be able to spend that much to order medication they’re not certain to need.

Medication abortion is a method by which someone ends their pregnancy by taking two pills – mifepristone and misoprostol – rather than having a surgical procedure. The drugs can be taken immediately after someone learns that they’re pregnant and up to 10 weeks after the first day of the last menstrual period.

More than half of all abortions in the US are medication abortions, and it’s becoming increasingly common, according to data from the US Centers for Disease Control and Prevention.

Medication abortion remains legal in the US but has been challenged in the courts. The US Supreme Court announced last month that it would consider whether to restrict access to mifepristone, a decision that could upend the US Food and Drug Administration’s approval and regulation of the drug that has been considered “safe and effective” for decades.

A number of Democratic-led states – including New York, California and Massachusetts – have said that they were stockpiling the pills that can be used for a medication abortion.

“Anti-choice extremists have shown that they are not stopping at overturning Roe, and they are working to entirely dismantle our country’s reproductive health care system, including medication abortion and contraception,” New York Gov. Kathy Hochul said in April. “New York will always be a safe harbor for abortion care, and I am taking action to protect abortion access in our State and continue to lead the nation in defending the right to reproductive autonomy.”

CNN’s Jen Christensen and Meg Tirrell contributed to this report.

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