New research out in JAMA finds that provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. These results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.
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Advance Provision of Medication Abortion
New Project SANA research “Advance Provision of Mifepristone and Misoprostol via Online Telemedicine in the US” was published on January 2nd 2024 in JAMA Internal Medicine.
Advance provision of abortion medications is the prescription of mifepristone and misoprostol before pregnancy occurs (or “just in case”). Physicians in the US do not routinely engage in advance provision, yet there is considerable interest among US populations. Following recent abortion bans, advance provision could allow people to have abortion medications immediately available if needed. Using data from Aid Access, an online telemedicine service that has offered advance provision since September 2021, we examined trends in the demand and characteristics and motivations of requestors.
Project SANA in the Upshot
A new analysis from The Upshot “Most Women Denied Abortions by Texas Law Got Them Another Way” shows that overall abortions since the passage of Senate Bill 8 have declined much less than previously known, because women traveled out of state or ordered pills online.
Using Project SANA data on online requests for abortion pills in combination with additional research on out of state travel for abortion care, the piece argues that the total number of abortions by Texans has fallen by around 10 percent.
“The law is semi-effective; it will not stop all abortions,” said Abigail R.A. Aiken, lead investigator of Project SANA.
The article suggests that the same patterns may not hold nationwide if Roe v. Wade is overturned because abortion access would be even harder than it has been for Texans.
New Yorker Profile, Abigail Aiken
The New Yorker has profiled Project SANA lead investigator Abigail Aiken in a new piece, “What does an at-home abortion look like in 2021?”
The profile focus on why Aiken–an outstanding student growing up in Northern Ireland–decided to focus her talents on the study of abortion access. As a young woman, Aiken faced a possible pregnancy in a country in which abortion was illegal. Her feelings of relief upon learning she was not pregnant–or was no longer pregnant, she never knew–propelled her to study others seeking self-managed abortion.
The profile further chronicles her work, including collaborations with Women on Web and Aid Access, and her decision to settle in Texas, because she was “interested in being somewhere where reproductive rights are important.”
The article notes that Aiken’s research has helped to change perceptions of abortion pills—and of self-managed abortions in general. Aiken’s data continue to suggest that, when pills are used, inducing an abortion at home is as safe as going to a clinic.
The article concludes by focusing on Aiken’s decision two years ago to have a child: “Parenthood can only be a choice if abortion is allowed.”
New Washington Post Perspective by Abigail Aiken
A new piece by Abigail Aiken for the Washington Post Perspective section entitled “The next normal: The future of medication abortion is at home” examines the possible transformations of at-home medication abortion.
The essay discusses how state-level restrictions have “sparked innovation in where and how people access the medication.” Aid Access, the first online telemedicine service to provide self-managed medication abortion to people living in the United States, was launched in 2018 and operates outside of the formal healthcare system. Furthermore, in some states, the formal healthcare system adapted during COVID-19 and increased telemedicine and mail-based services for abortion care.
Discussing how uneven access to at-home medication abortion is via the formal healthcare system throughout the United States, the piece concludes: “Will we accept a two-tiered system based on Zip code, where some have access to at-home services through the health-care system while others must risk criminalization, or can we envision a future where a full spectrum of options are equally accessible to all? At-home medication abortion is here to stay. The question is: in what form?”
New Publications
The Project SANA team has two new publications.
The Project SANA team has two new publications. “The economic context of pursuing online medication abortion in the United States,” available in SSM: Qualitative Research in Health, examines how financial circumstances shape alternate pathways to abortion care when clinics are out of reach. Using in-depth interviews, the authors find that the cost of in-clinic care exacerbated by restrictive policies negatively impacted clinic access for participants. The study concludes that the availability of affordable telemedicine and policy interventions addressing Medicaid and insurance coverage for abortion would increase abortion access for populations with low incomes.
A second paper, “Factors Associated With Use of an Online Telemedicine Service to Access Self-managed Medical Abortion in the US,” is available in JAMA Network. In this study of over 57,000 individuals in the US, clinic access barriers were the most common reason for accessing self-managed medication abortion. Both distance to an abortion clinic and living below the federal poverty level were associated with higher demand for self-management. State and federal legislation could address these access barriers.
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