Self-managed abortion medication distribution outside formal settings rose after Dobbs

Key takeaways:

• Self-managed abortion medication distributed by sources outside of formal settings rose after Dobbs.
• After Dobbs, the estimated number of medication distributions increased, even when accounting for nonuse.

Distribution of medication for self-managed abortion from sources outside of formal health care settings increased 6 months after the Dobbs decision, despite state-level bans and restrictions, according to findings published in JAMA.

Self-managed abortion is the process of using methods, such as herbs, botanicals, self-harm and medications, to end a pregnancy without the help of a health care provider. Abortion medications such as mifepristone (Danco Laboratories) and misoprostol (Pfizer) have been increasingly used for self-managed abortion, according to Abigail R.A. Aiken, PhD, associate professor and fellow of the Richter Chair in Global Health Policy at the Lyndon B. Johnson School of Public Affairs at the University of Texas at Austin, and colleagues.

“Prior research has found increased demand for self-managed medication abortion in response to sudden policy changes, such as short-term bans on abortion under COVID-19 restrictions in 2020 and the implementation of a 6-week gestational limit on abortion in Texas in 2021,” the researchers wrote. “Moreover, requests for self-managed medication abortion through the online telemedicine service Aid Access showed sharp increases immediately after Dobbs, especially in states with bans. Yet, beyond increased demand, little else is known about the number of provisions of medication for self-managed abortion in the wake of Dobbs.”

Aiken and colleagues conducted a cross-sectional study utilizing data from online telemedicine organizations, community networks and online vendors that provided abortion medications outside of the formal health care setting to individuals in the U.S. from March to December 2022. The sources shared data on monthly self-managed abortion medication distribution from before (March to April 2022) and after (July to December 2022) Dobbs. Researchers estimated changes in self-managed abortion medication distribution outside of formal health care settings after Dobbs and the actual use of these medications.

Overall, researchers identified 15 unique sources encompassing 28 sub-sources that provided medications outside of formal health care settings for self-managed abortion. Across all source types, there was a monthly average of 5,931 distributed medications for self-managed abortion during the 6-month period after Dobbs, whereas the monthly average before Dobbs was 1,407. After Dobbs, community networks accounted for 51.4% of monthly distributed medications; telemedicine organizations outside of formal health care settings accounted for 37.2%; and online vendors accounted for 11.4%.

When including imputed missing values from sources that did not provide data, the estimated actual number of distributed medications for self-managed abortion 6 months after Dobbs was 38,463 across all sources compared with the 10,677 expected based on data before Dobbs. This indicated an increase of 27,838 total distributed medications for self-managed abortion after Dobbs. When evaluating distribution totals excluding imputed values, the numbers were 35,587 after Dobbs compared with the 8,442 expected based on data before Dobbs, the researchers wrote.

When accounting for medication nonuse, researchers estimated an increase of 26,055 distributed medications for actual self-managed medication abortions when including imputed values and 25,458 when excluding imputed values.

Limitations noted in the study include the possibility that abortion medication shipments from two or more sources were for the same person, and sources may not have distinguished advance distribution from distribution intended for immediate use. In addition, the researchers were unable to verify data from all sources and obtained only 2 months of data from before Dobbs.

“Further research is needed to determine the relative contributions of various service delivery models in restrictive states. In the meantime, self-managed medication abortion will likely remain a significant contributor to abortion access in the post-Roe U.S.,” the researchers wrote. “Clinicians will need to be prepared to encounter patients who may be considering self-managed medication abortion or who need or want to connect with the formal health care setting for post-abortion care.”