Telemedicine requests for advance abortion medication rise after Dobbs

Key takeaways:

• Common reasons for advance provision were to ensure personal health and choice and to prepare for abortion restrictions.
• States with a high likelihood of abortion bans had more requests vs. states without bans.

Telemedicine requests for advance provision of abortion medications increased following Dobbs and FDA mifepristone rulings, according to study results published in JAMA Internal Medicine.

“Advance provision of abortion medications is the prescription of mifepristone and misoprostol before pregnancy occurs. Physicians in the U.S. do not routinely engage in advance provision, yet there is considerable interest among U.S. populations,” Abigail R. A. Aiken, PhD, associate professor of public affairs and fellow of the Richter chair in global health policy at LBJ School of Public Affairs at the University of Texas at Austin, and colleagues wrote. “Following recent abortion bans, advance provision could allow people to have abortion medications immediately available if needed.”

Aiken and colleagues conducted a cross-sectional study that included 48,404 requests for advance provision of abortion medications via Aid Access, an online telemedicine service, from September 2021 to April 2023 from residents from all 50 states and Washington, D.C. Researchers compared the mean daily request rate at baseline (September 2021 to May 2022), after the Dobbs decision leaked (May to June 2022), after the Dobbs decision was announced (June 2022 to April 2023) and during conflicting rulings on the challenge to FDA mifepristone approval (April 2023).

States were categorized as states with abortion bans after Dobbs (n = 13), states with 6-week bans (n = 2), states plus Washington, D.C., with likelihoods of bans or restrictions (n = 13) and states with no current or planned changes (n = 22).

More requests for advance provision of abortion medications were made by women aged 30 years or older (34% vs. 27%), who self-identified as white (67% vs. 39%), had no children (75% vs. 48%), lived in urban regions (82% vs. 77%) and lived in regions with poverty rates less than the national average (38% vs. 31%) compared with women who requested self-managed abortion. The most common reasons for requests were to ensure personal health and choice (74%) and to prepare for possible abortion restrictions (73%).

The mean number of daily requests per 100,000 female U.S. residents aged 15 to 44 years was 24.8 during baseline, 247.3 after the Dobbs leak, 89.1 after the Dobbs decision and 172.1 after conflicting rulings for the FDA approval of mifepristone. After the Dobbs leak, mean weekly request rates increased from 0.4 to 3.5 per 100,000 women in states where abortion bans were likely. After the Dobbs decision, requests were highest in states with a likely future abortion ban compared with states without.

“A key focus for services will be ensuring affordability, visibility and access for racial and ethnic minority groups and marginalized groups,” the researchers wrote.