On Sunday, FiveThirtyEight released data showing that there were at least 10,000 fewer legal abortions in July and August than before the Supreme Court’s decision to overturn Roe v. Wade. The numbers — from #WeCount, a research project funded by the pro-abortion-rights nonprofit Planned Parenthood — offered a detailed, if incomplete, picture of how abortion in the United States has changed since the Dobbs decision in June.
However, one key question remained unanswered: How many people who were unable to obtain a legal abortion did so through another method?
A new research paper published today begins to answer that question. It shows that Aid Access, an international abortion pill service that distributes medical abortions in places where it is illegal, received a total of 6,533 more pill requests from the United States in July and August 2022, each month compared to the April 2022 baseline. year . A preliminary analysis of Aid Access data suggests that about 50 to 60 percent of requests result in completed abortions, which would mean at least an additional 3,267 abortions in July and August combined compared to the April baseline. While this estimate is imprecise, the growth demonstrates the role that self-abortion now plays in shaping abortion access in America.
“Every time we see a policy that restricts abortion, we see an increase in demand for access to care,” said Dr. Abigail Aiken, a professor of public affairs at the University of Texas at Austin and one of the study’s co-authors. “The evidence we’ve seen shows us that when you ban or severely restrict abortion, you do nothing to change the need for abortion. But you seem to be changing how and where people get help.”
Aid Access, the abortion provider at the heart of the study, was founded in 2018 by Dutch activist Dr. Rebecca Gomperts, who also co-authored the paper. Aid Access occupies a kind of legal gray area — in 2019, the Food and Drug Administration tried to stop the organization from shipping pills to the U.S., saying Aid Access was violating federal law by distributing misbranded and unlicensed drugs, but it’s not succeeded, and Gomperts has repeatedly stated that her organization complies with the law. Three states—Oklahoma, South Carolina, and Nevada—make it a crime to perform an abortion on your own, and 19 states outlaw the remote prescription of abortion pills. Also, in many cases, Americans import drugs from abroad for personal use illegally. But these laws are difficult to enforce and individuals are rarely prosecuted, essentially creating a legal loophole for groups like Aid Access and the people who use their services.
Having served clients in the United States for several years, Aid Access has data that spans several phases of American abortion policy. The organization requires clients to fill out a form detailing their medical history and reason for requesting abortion pills, which is reviewed by a medical professional. If there are no medical red flags in this own data, the organization sends the pill to the requester.
After the constitutional right to abortion was repealed in June, the Aid Access online request form exploded. According to a new paper, the number of weekly requests for abortion pills from Aid Access has increased in a number of states, with the biggest increase coming from people in states that completely ban abortions. For example, Louisiana, Mississippi, Arkansas, Alabama and Oklahoma — all of which enacted near-total abortion bans by early July — saw the largest increases in requests.
In these states, some people may see an organization like Aid Access as their only option. Another paper published today by Ushma Upadhyay, a professor and public health sociologist at the University of California, San Francisco, found that since the Supreme Court decision, roughly one-third of women of reproductive age in the U.S. live in a census tract more than hours from an abortion facility. For people living in Texas, the estimated travel time to an abortion clinic has increased by nearly eight hours.
The availability of the abortion pill, which if taken early in pregnancy leads to a process very similar to early miscarriage, has changed the way abortion is done in the US. Medical abortion was already gaining popularity, even before abortion rights seemed to be under serious threat. A study released by the Guttmacher Institute earlier this year found that medical abortion accounted for more than half (54 percent) of abortions in 2020, up from 39 percent in 2017. The vast majority of abortions in the US occur in the first trimester, which means abortion. the pill — which is FDA-approved for use up to the 10th week of pregnancy — is an option for many patients. During the COVID-19 pandemic, changes in the regulation of abortion pills allowed them to be legally prescribed via telemedicine in some states. Since then, several online abortion services have appeared. These companies operate legally in the US and can only ship pills to states where abortion is legal. They also offer virtual medical supervision in case of complications.
However, medical abortion is not only used for legal abortions—it is also a safe method of termination of pregnancy that is difficult to detect outside the medical and legal system. In the era before Roe v. Wade, various methods of self-induced abortion often resulted in infection or other serious health problems. However, it is now relatively easy for people to order abortion pills online from services such as Aid Access.
Medical abortion is effective and low-risk—even when used outside of a clinical setting. A study published earlier this year of nearly 4,000 women who received the abortion pill without an in-person visit found that 95 percent of the abortions were completed without the need for further medical intervention, and less than 1 percent resulted in serious complications. But it can also be very painful for some, and there’s no real way to know in advance what kind of experience one person will have. Aiken said hotline services for self-monitored miscarriages and abortions can help people cope with this variability at home, but also noted that the use of medical abortions and illegal providers such as Aid Access is on the rise even in states where abortion remains legal . “There was a significant proportion of people who said, ‘I’m making this request because I prefer the comfort and privacy of my own home,'” she said. “They have a choice, they can go to the clinic, they can do something else, but really they choose to manage themselves.”
After all, pill providers like Aid Access represent a safe way to get an abortion yourself — something that didn’t exist in the pre-Roe era. “So as long as the bans are in place, I think we’re going to see those numbers hold steady, if not go up,” Aiken said.