As some states rushed to restrict abortion amid the coronavirus pandemic, one new study has found an increased demand in self-managed abortions. Unsurprisingly, many of these requests are happening in states with more severe restrictions as well as more serious COVID-19 outbreaks.
The study, published in the Obstetrics and Gynecology journal, tracked requests for medication abortion by mail through data from Aid Access, an online medication abortion pill provider, during the beginning of the coronavirus pandemic's spread and consequent lockdown measures in the U.S.
Researchers found that from March 20 to April 11, there was 27% increase in the rate of requests across the U.S., with larger upticks in requests coming from states that took measures to limit abortion access during the pandemic. For example, Texas, which banned medical procedures "that are not immediately medically necessary" — including abortions not related to life endangerment — saw a 94% increase in requests for medical abortion by mail. The largest increases also came from states where the coronavirus outbreak was the most critical at the time, such as New York and New Jersey.
Medication abortion, or the "abortion pill," works by using two different medicines to end a pregnancy: mifepristone and misoprostol. Abigail R. A. Aiken, PhD, the author of the study, says getting abortion pills by mail from a service like Aid Access means that a doctor reviews your medical history, the pills are prescribed in the correct dose, and you have access to full instructions on how to use the pills, as well as what to expect to see and feel. These are the same pills that would be given in a clinic or doctor's office, and studies have suggested telemedicine abortions are as safe and effective as in-person care. According to Planned Parenthood, you can usually get a medication abortion up to 77 days (11 weeks) after the first day of your last period. If it has been 78 days or more since the first day of your last period, you can have an in-clinic abortion to end your pregnancy.
Earlier this month, a federal judge agreed to suspend a rule that requires people to visit a hospital, clinic, or medical office to obtain an abortion pill during the COVID-19 crisis. District Judge Theodore Chuang ruled that the in-person requirements for patients seeking medication abortion care impose a "substantial obstacle" and are likely unconstitutional under the circumstances of the pandemic.
"Particularly in light of the limited timeframe during which a medication abortion or any abortion must occur, such infringement on the right to an abortion would constitute irreparable harm," he wrote. "By causing certain patients to decide between forgoing or substantially delaying abortion care, or risking exposure to COVID-19 for themselves, their children, and family members, the In-Person Requirements present a serious burden to many abortion patients."
Though the study's timeline took place before Chuang's ruling, Dr. Aiken says the demand for self-managed abortions such as telemedicine abortions will likely remain in places where state-specific laws still prohibit the use of telemedicine for consultation with a provider.
Dr. Aiken also believes that even after the pandemic, the demand for self-managed abortions will continue.
"People in the United States have been having self-managed abortions for a very very long time," she says. "What's changed relatively recently, however, is what these self-managed abortions look like. The availability of services like Aid Access has made self-managed abortion using pills more accessible than ever before."
She added that while the study showed an increased demand for self-managed medication abortion as COVID-19 began to spread, it also shows that Aid Access was receiving thousands of requests long before the pandemic started. The demand, she says, can be attributed partly to a preference for the convenience, independence, and privacy self-management offers, as well as to the reality for many people in the U.S. — that in-clinic abortions may already be out of reach due to state laws that have made care inaccessible due to cost, distance, and unnecessary requirements such as waiting periods.