Threats to abortion access drive demand for abortion pills, analysis suggests

People concerned about potential new abortion restrictions appear to be more likely to request abortion pills even if they're not yet pregnant, according to a new analysis.

Abigail Aiken, a public affairs professor at the University of Texas at Austin, examined data from more than 48,000 requests from people seeking the pills for potential future use — a practice known as advance provision — through Aid Access. The organization based in Europe provides medication abortion to U.S.-based patients through telemedicine and the mail, at a cost of $150.

Requests for advance provision spiked at times and in locations where patients appeared to perceive threats to abortion access, Aiken says, such as around the time a draft U.S. Supreme Court decision was leaked in Dobbs v. Jackson Women's Health Organization, the case that overturned a constitutional right to an abortion.

"Requests ... go up and they go up quite rapidly," she says. "So it seems possible that people are really responding to the threat of reduced abortion access."

Aiken noted a similar increase in the spring of 2023, when a lawsuit challenging access to mifepristone was working its way through the legal system. The U.S. Supreme Court is expected to weigh in on that case next year.

Abortion, in advance

Advance provision typically involves a standard regimen for medication abortion involving two drugs, mifepristone and misoprostol. The pills are provided to patients who are not yet pregnant but believe they may at some point wish to access abortion pills.

It is not a routine part of reproductive health care in the United States, Aiken says. But Aid Access began offering it around the time Texas implemented its anti-abortion law known as SB 8, in September 2021. That law bans most abortions after about six weeks of pregnancy, and allows individuals to file lawsuits against people accused of helping with the provision of an illegal abortion.

In response to a request for comment on Aiken's analysis, the American College of Obstetricians and Gynecologists (ACOG) described mifepristone as "a very safe and effective drug," and said the data suggest that "people are worried about needing abortion care and being unable to access it in the future due to abortion bans. While some people may be able to travel to states where that care is legal, others simply cannot."

ACOG added that federal health regulations limiting how mifepristone can be prescribed "unfortunately ... leave patients unable to access mifepristone and clinicians unable to prescribe it in advance."

Nonetheless, Aid Access founder Dr. Rebecca Gomperts said in an email to NPR that some U.S.-based physicians living in states that have enacted protections for providers known as "shield laws" are prescribing the pills in advance. Gomperts said the medication has a shelf life of "at least two years as long as the blister pack is kept sealed, and is not exposed to heat, light, or moisture."

On its website, Aid Access encourages patients who obtain the pills in advance and later wish to use them to terminate a pregnancy to contact the organization for guidance through the process.

More anti-abortion proposals, more requests for abortion pills

In addition to the timing of requests, Aiken analyzed the locations of patients who sought advance provision. She saw spikes in requests from states where abortion restrictions were being proposed by lawmakers.

"The biggest increases seem to be in states where there's potential legislation coming," she says. "It seems like people are reacting to that potential threat to access with, 'Oh, I better get prepared for what might be coming.' "

Patients who requested the pills in advance were older, more likely to be white, and lived in relatively lower-poverty areas, compared with those who were requesting medication abortion to terminate a current pregnancy. Aiken says that may suggest that some younger patients and people of color face barriers that make them less likely to request advance provision.

The pills provided in advance by Aid Access were not covered by insurance, Aiken says.

"We know that people struggle to afford, say, $100 even for abortion care they currently need," she says. "So it might be a very different financial calculus, and these financial barriers might loom large for people."