More women are ordering abortion pills for future use

There is a significant and sustained demand for the advance provision of abortion medications through telehealth services before a pregnancy occurs, according to a study  published this month in the Journal of The American College of Obstetricians and Gynecologists. 

A cross-sectional study using electronic medical records across 23 states and the District of Columbia showed a continued demand for abortion pills for future use over a 20-month period between August 2021 and March 2023. Authors then compared patients who ordered abortion medications for future use with those who ordered for a current pregnancy.  

Advance provision patients - those who receive abortion medications ahead of time, often in anticipation of a potential need - do not mirror the demographics of individuals who traditionally face barriers to accessing abortion care, according to lead author, Anna Fiastro, a researcher in the Department of Family Medicine at the University of Washington School of Medicine. 

Seventy-two percent of those who preordered the pills for future use were white and most did not have children (80%). Forty-two percent of those who ordered pills during a pregnancy identified as white, the study authors noted. Those who ordered for an existing pregnancy were younger - and were also more likely to have children.

Individuals who self-identified as Black or Hispanic accounted for only 2.4% and 5.3%, respectively, of the advance provision patients. Among those requesting abortion pills because they were pregnant, 20% identified as Hispanic, 14% Black and 5% Asian.  

Only 38% of the advance provision patients resided in counties considered low resourced –areas of high poverty and inadequate health and social services - compared to almost half of the other pregnant patients studied, authors noted. They also primarily lived in large metro areas.  

The top reason patients chose to order in advance was personal choice (81%) and concern for future legal restrictions (70%). For those wishing to end a pregnancy, the top reason given was privacy (65%) and comfort of being at home (69%).  

“What we were most interested in was who was using the advance provision option and how they differ from patients ordering abortion medications for a current pregnancy,” Fiastro added. “These findings shed light on how this option (advance provision) can possibly alleviate barriers in accessing reproductive healthcare due to state-level abortion restrictions and what more needs to be done so that this tool is available to those who may need it most.” 

“We also noticed huge spikes in people ordering pills when there were political moments, such as the overturning of Roe v Wade, or media covering abortion care or restrictions," she said. The U.S. Supreme Court overturned the constitutional right to an abortion in June 2022 in the Dobbs decision.  Surges in advance prescriptions came with four legislative events during the study period:  The December 2021 oral arguments before the U.S. Supreme Court of Dobbs vs. Jackson, the May 2022 leak of the draft decision in Dobbs, and the June 2022 U.S. Supreme Court decision on Dobbs. The most recent spike in the study came in 2023, when it looked like mifepristone, the first pill taken during a medication abortion, might be banned. The drug remains on the market. 

The study reviewed 3,252 advance provision patients, and 23,317 pregnant patients who received abortion medications to end a pregnancy. All received the medications from the clinician-supported telehealth service, Aid Access. Each patient was screened to determine if the medications were for future use, or if they were currently pregnant and under 13 weeks' gestation.  

Fiastro said cost ($80) and knowledge of this service may be at play here.  

The study did not look at states that have banned abortions completely. However, past research has shown consistent demand for telehealth provision of abortion medications in abortion restrictive settings, Fiastro noted.  

“Continued research will be crucial to understanding how this method of medication delivery can meet the needs of diverse populations and ensure that individuals can make informed, timely decisions about their reproductive health,” Fiastro said. 

Providing these medications to patients before they are pregnant may further help address barriers to accessing safe and timely abortion care, report authors concluded.  

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