Test, published Monday in the medical journal JAMAfound that the number of abortions using pills obtained outside the formal health care system increased in the six months after the overturning of the country’s abortion law. Another report, published last week by the Guttmacher InstituteA research organization that supports abortion rights found that medication abortions now account for nearly two-thirds of all abortions performed in the country’s formal health care system, which incorporates clinics and telemedicine abortion services.
The JAMA study assessed data from foreign telemedicine organizations, online sellers and volunteer networks that typically source the pills from outside the United States. Before Roe was overturned, these facilities provided abortion pills to about 1,400 women a month, but over the next six months the average number increased to five,900 a month, the study found.
Overall, the study found that while the number of abortions in the formal health care system fell by about 32,000 from July to December 2022, much of this decline was offset by about 26,000 medical abortions using pills provided by sources outside the formal system health care.
“We’re seeing what we’re seeing in other parts of the world, in the U.S. — that when anti-abortion laws go into effect, people often look outside of formal health care settings, and that changes the setting of care,” said Dr. Abigail Aiken, an associate professor at the University of Texas at Austin and lead writer of the JAMA study.
The co-authors were a professor of statistics at the university; founder of Aid Access, a European organization that helped pioneer telemedicine abortions in the United States; and leader of Plan C, a company that provides consumers with details about medical abortion. Before publication, the study underwent a rigorous review process required by a significant medical journal.
The telemedicine organizations in the study assessed potential patients using written medical questionnaires, issued prescriptions from doctors who were typically based in Europe, and shipped the pills from pharmacies in India, often for about $100. Social networks typically asked for some details about pregnancy and provided or sent pills with detailed instructions, often without cost.
Online sellers, who supplied a small percentage of the pills in the study and charged fees starting from $39 to $470, generally didn’t ask women about their medical histories and sent the pills with the least detailed instructions. The providers included in the study were reviewed under Plan C and located to be providing real abortion pills, Dr. Aiken said.
The Guttmacher Report, specializing in the formal health care system, includes data from clinics and telemedicine abortion services in the United States that performed abortions on patients who lived in or traveled to states where abortion was legal between January and December 2023 .
It found that the pill contributed to 63 percent of those abortions, up from 53 percent in 2020. The total number of abortions included in the report exceeded a million for the first time in greater than a decade.
Why it matters
Overall, the latest reports suggest how quickly abortion availability has adjusted in the face of post-Roe abortion bans in 14 states and stringent restrictions in others.
The numbers could also be underestimates and don’t reflect a recent change: shield laws in six states, allowing abortion providers to prescribe and ship the pills to tens of hundreds of women in states with bans, without having to travel. For example, since last summer Aid Access stopped sending medicines from abroad and stopped operating outside the formal healthcare system; as an alternative, it mails the pills to banned states from the United States, under the protection of shield laws.
What’s next
In a case that will probably be heard before the Supreme Court on Tuesday, anti-abortion plaintiffs are suing the Food and Drug Administration in an effort to dam or drastically limit the availability of mifepristone, the first pill in the two-drug abortion regime.
The JAMA study suggests that such a ruling could prompt more women to use options outside the formal U.S. health care system, equivalent to pills from other countries.
“There are a lot of unknowns about what will happen with this decision,” Dr. Aiken said.
She added: “It is possible that a Supreme Court decision in favor of the plaintiffs could have a knock-on effect of more people wanting access outside of a formal healthcare setting, or out of fear that access to healthcare will lapse. or have greater problems accessing medicines.”
