Results of a recent study indicated that online abortion medication demand is highest in states with restrictive abortion policies. Findings showed that from Oct.15, 2017, to Aug. 15, 2018, 6,022 people living in the United States requested abortion medications from an online service. While requests came from across the nation, states with restrictive abortion policies saw higher volumes of requests.1

Drugs similar to those used in the U.S. medication abortion regimen are available online, as well as information on how to safely and effectively self-manage abortions. March 2018 saw the launch of Aid Access, a service that provides medication abortion pills via mail order to people living in the United States. Around 2,500 prescriptions reportedly were filled in that year.2

Researchers analyzed consultation forms from U.S. residents requesting abortion medications from Women on Web, an online abortion telemedicine service. The nonprofit organization provides abortion medications to people in countries without access to safe abortions. While Women on Web does not send abortion medications to the United States, it does field requests from American residents. Researchers used the organization’s consultation forms, which include demographic characteristics, medical history, and motivations for seeking abortion medications online, for analysis.

According to the researchers, 76% of requests for medication came from people living in states with restrictive abortion policy climates. Mississippi, where 24.9 per 100,000 women of reproductive age requested medication, was the state with the highest number of requests, followed by Louisiana, Alabama, Tennessee, and Texas. One-quarter of requests came from women living in states with more supportive abortion policies. New Hampshire had the lowest rate of requests.

Difficulty accessing clinical care and personal preferences were the leading reasons for seeking abortion medications online, researchers report.

“In both states that have passed many abortion restrictions and states that have passed fewer, people are motivated by a combination of barriers to clinic access and a preference for at-home care,” said lead author Abigail Aiken, MD, MPH, PhD, assistant professor of public affairs at the LBJ School of Public Affairs at the University of Texas at Austin.

Barriers for women differed according to state policy environment, researchers noted. Legal barriers to clinic access, such as waiting periods, and the cost of in-clinic abortion care, were experienced more commonly in states with restrictive abortion policies.1

“These results suggest that state policies restricting access to abortion have made it harder for some people to access care in the clinic setting, and so they look online for alternatives,” Aiken said.3

Efforts Underway to Expand Access

A network of providers, researchers, and advocates is working toward access to the full range of safe and effective options for abortion services for U.S. women, including self-managed methods. The FDA-approved regimen for medication abortion is sanctioned for use up to 70 days since the patient’s last menstrual period. It consists of two medications: mifepristone, which works by blocking progesterone, and misoprostol, which is taken 24 to 48 hours later to induce contractions and end the pregnancy.4

To check the online availability of medication abortion drugs, researchers identified 18 websites and ordered 22 products: 20 mifepristone-misoprostol combination products, and two that contained only misoprostol. A total of 18 combination products and two misoprostol products were received from 16 different sites. No site required a prescription or any relevant medical information. Researchers reported the time between order and receipt of products ranged from three to 21 business days, with prices ranging from $110 to $360 for the combination products. Products without mifepristone cost less. Based on chemical analysis, researchers determined that the 18 tablets labeled 200 mg mifepristone contained between 184.3 mg and 204.1 mg mifepristone, while the 20 tablets labeled 200 mcg misoprostol contained between 34.1 mcg and 201.4 mcg of the active ingredient.5 Women can access a report card on online medication abortion sites by visiting: www.plancpills.org.

How should healthcare providers prepare to deal with patients who are considering or have accessed self-care sites? The Bixby Center for Global Reproductive Health at the University of California, San Francisco offers the following tips that providers may consider in addressing patients’ needs in the safest way possible:

• Assess patients for health risks, determining gestational age and viability;

• Provide information on what methods are safest to try on their own and which are riskier;

• Counsel on warning signs, what to expect, and what to say if they present at a healthcare facility with complications;

• Understand the legal implications and educate other providers. Providers have no duty to report self-managed abortions — and, in fact, may violate patient privacy laws by doing so. The majority of women prosecuted for pregnancy loss have been reported by someone within the healthcare system;

• Provide compassionate care to patients who present with complications from self-managed abortions.6

REFERENCES

  1. Aiken ARA, Starling JE, van der Wal A, et al. Demand for self-managed medication abortion through an online telemedicine service in the United States. Am J Public Health 2019; doi: 10.2105/AJPH.2019.305369.
  2. Jones RK, Witwer E, Jerman J. Abortion Incidence and Service Availability in the United States, 2017. Available at: https://bit.ly/37ntM9M.
  3. University of Texas at Austin. Requests for online abortion medication are highest in states with restrictive abortion policy climates. Oct. 17, 2019. Available at: https://bit.ly/356kxsM.
  4. Donovan MK. Self-managed medication abortion: Expanding the available options for US abortion care. Guttmacher Policy Rev 2018;21:41-47. Available at: https://bit.ly/2Obev4j.
  5. Murtagh C, Wells E, Raymond EG, et al. Exploring the feasibility of obtaining mifepristone and misoprostol from the internet. Contraception 2018;97:287-291.
  6. Bixby Center for Global Reproductive Health. Self-managed abortions: What healthcare workers need to know. Available at: https://bit.ly/2Qt3sFr.