As state- and federal-level Republicans continue to impede on abortion rights, pro-choice efforts to encourage expanded access to abortion-related services and facilities is much needed. Several states, mostly in the South, have only one abortion clinic left within their state lines.
Not surprising to women and abortion care providers, barriers like distance and affordability are reasons why women request self-managed medication abortion via telemedicine, according to a new study.
“Policies restricting access to in-clinic abortion have increased over the past decade, and some findings suggest that the decrease in the rate of in-clinic abortions has been associated with residence in states with more restrictions,” first author Abigail R. A. Aiken, MD, PhD, of the University of Texas, wrote in the study.
Roughly 19 states require the prescribing physician to be in the physical presence of the patient for medication abortion, making abortions via telemedicine illegal in these states.
The current reproductive rights landscape explains why so many women are turning to self-managed medication abortion, in states where its legal. Several states have passed recent legislation that would ban abortions within the first and second trimesters. Additionally, the Supreme Court will hear the Dobbs v. Jackson Women’s Health case, to determine the constitutionality of a 15-week abortion ban. The high-profile case could be the catalyst that overturns Roe v. Wade and rolls back abortion rights by 50 years.
Between March 2018 and March 2020, more than 57,500 individuals requested medication abortion from Aid Access, a nonprofit organization that provides access to abortion medications by mail in the US. The highest rates of requests for medication abortion were found in states that had the most restrictive abortion policies. So why did patients decide to get medication abortion?
Of the respondents:
74% noted the inability to afford an in-clinic abortion.
49% were afraid of a partner or family member finding out if they tried to go to a clinic.
40% noted the nearest clinic was too far away.
38% were unable to take time away from work or school to go to a clinic.
28% reported being more comfortable self-managing their abortion at home.
27% noted self-managing their abortion at home would be more convenient.
“With many states planning further restrictions on in-clinic abortion and the possibility that Roe v. Wade will be severely diminished by Supreme Court rulings, we may expect to see demand for self-managed medication abortion increase,” the researchers wrote in their study.
The good news is the FDA is currently conducting a review of mifepristone, the pill that is typically used in medication abortions. Both the Biden administration and pro-choice advocates hope the FDA finds the current restrictions, such as the physical presence of the prescribing physician, to be unnecessary. This comes after the FDA paused enforcement of the in-person dispensing requirement during the Covid-19 pandemic to stop the potential spread of the virus.
“For policy makers, increased demand means that the consequences of laws that make in-clinic abortion less accessible and the expansion of medication abortion access should be considered to help overcome existing barriers and meet patients’ preferences,” the researchers noted.
The study was published in JAMA.