More Americans are now stockpiling abortion pills in case they get pregnant, according to new research published Tuesday.
Before Roe v Wade was overturned in June 2022, Aid Access, an organization that mails abortion pills to people across the US, received an average of 25 requests a day from people seeking the pills despite not being pregnant. After the leak of the supreme court decision to overturn Roe, that average shot up to 247 requests each day, the research published on Tuesday found.
That number fell after the actual decision, but rose again to 172 a day in April 2023, as US courts signaled a willingness to restrict the availability of a major abortion pill.
People have been turning to Aid Access for “advance provision” pills since September 2021, after Texas enacted a six-week abortion ban but long before the US supreme court overturned Roe and abolished the national right to abortion. Now, with wide swathes of the US south and midwest under abortion bans, an online market to request and obtain abortion pills is thriving.
The study tracks requests between the beginning of September 2021 and the end of April 2023. In December 2023, the US supreme court announced that it would hear arguments in a case regarding the future of mifepristone, a major abortion pill. That case is expected to be decided by this summer.
In total, over the study’s time frame, Aid Access tracked roughly 48,400 advance provision requests. It received more requests for advance provision pills from states that were anticipated to enact bans – even more than the requests from states that did enact bans.
“It seems to suggest that what people are reacting to is the threat of reduced access, the threat of curtailment of reproductive rights,” said Dr Abigail Aiken, an associate professor at the University of Texas at Austin and a co-author of the study. “When you think about what advanced provision is, that makes sense, right? Advanced provision is getting out ahead of things. Advanced provision is advanced planning. Advanced provision is a way to protect a potential need you might have in the future if you think access to the service that would fulfill that need is going away.”
Over the study period, Aid Access also received more than 147,00 requests from people seeking to end their existing pregnancies. Medical experts widely agree that it is safe to “self-manage” your own abortion, or perform an abortion outside of the formal US healthcare system, using pills within the first trimester of pregnancy.
Compared with the people who wanted to terminate their existing pregnancies, people who sought advance provision pills were more likely to be white, child-free and living in urban areas. Choosing from a list of reasons, they most frequently told Aid Access that they wanted the pills to “ensure personal health and choice” and to “prepare for possible abortion restrictions”.
Aid Access was launched in 2018 by Dr Rebecca Gomperts, a Dutch physician and one of the most visible abortion providers in the world. Gomperts, who co-authored the study published Tuesday, previously founded Women on Web, an organization that, like Aid Access, shipped abortion pills. However, Women on Web didn’t provide pills to the United States. Ultimately, Gomperts decided that the state of abortion access in the country was too dire to ignore.
Advance provision pills cost $150 and should arrive within a few days of ordering, according to Aid Access’s website. During the time frame of the study, most of the pills were being shipped by overseas pharmacies, Aiken said.
Now, to send abortion pills, US-based physicians associated with Aid Access have begun to rely on what are known as “shield laws”: protections in Democratic states for abortion providers who prescribe pills for patients in abortion-hostile states. This transition to focusing on using US providers was part of the reason for the study’s conclusion in April, Aiken said.
“It made sense to look at a time period where the service was entirely outside of the formal US healthcare setting,” Aiken said. “Now, I think a lot of people would argue that it’s happening within the formal healthcare setting, because it’s US provider-led and -based.”
But while the US providers in blue states may be operating with the formal healthcare system, their patients in red states are not necessarily afforded the system’s protections and guidance. Someone who wants to get a check-up after an abortion, or even just talk to their doctor about their experience, may not feel able to.
“In terms of the experience of the person actually using the pills, it may still look a lot more like a self-managed abortion,” Aiken said. “What that means for the nature of the service is an ongoing, interesting question that we’re thinking about now in the research field.”
There was not much data available on what people ended up doing with the advance provision pills, Aiken said, since only a fraction followed up with Aid Access. However, of that fraction, most people still had the pills on standby months later.
Last year, Gomperts told the Guardian that she wanted people to stock up on pills to protect themselves.
“Don’t wait for the decision. Just get the medication now, get it in your house, get it in your hands,” she said. “If you’re in a war zone and the war is coming, you also make sure you have enough food in your house. This is how it feels. It really is a war. It’s a war on women.”
