Amid attacks on abortion rights, more look to manage care without medical help

The year 2021 is awash in anti-abortion bills, with over 500 abortion restrictions and over 150 outright bans introduced so far this year. Additionally, the U.S. Supreme Court recently agreed to hear a case about Mississippi’s 15-week abortion ban. It’s a grim time for abortion rights and access, which may be why people are seeking information on self-managed medication abortion. 

Self-managed medication abortions are when an individual takes the drugs that induce an abortion outside of a clinic setting, without the direct assistance of an abortion provider. Medication abortion is a very safe procedure, and research from other countries has shown that patients can safely and effectively manage medication abortion without direct assistance. 

A new study published in “Obstetrics and Gynecology” in May examined how many U.S. residents reached out to Aid Access, a nonprofit that provides online consultations for medication abortions, in the period from March 2018 to March 2020. In those two years, over 57,000 people from all 50 states requested information and assistance from the group.

For people in a dozen states with relatively liberal abortion laws, including California and New York, Aid Access connects patients with U.S. doctors who can prescribe the two drugs, mifepristone and misoprostol, used in a medication abortion.

For people in other states, Aid Access works with European doctors to prescribe the drugs. Prescriptions are then sent to a pharmacy in India, which then mails the medications to the patient. 

The highest rates of requests to Aid Access came from Louisiana and Mississippi, both states that restrict abortion access.

Louisiana has enacted far more abortion restrictions than any other state. 

Mississippi has marginally fewer restrictions, but 99% of the counties in the state have no abortion clinics, and 91% of Mississippi women live in those counties. 

Mississippi’s current 15-week ban stands in direct opposition to existing Supreme Court precedent concerning abortion laws, as it bans abortions before viability.

As the 5th Circuit Court of Appeals noted when it struck down Mississippi’s ban, there is “an unbroken line dating to Roe v. Wade” that holds that states can regulate abortion procedures prior to fetal viability but cannot ban abortions before that point. If Mississippi’s ban is upheld by the Supreme Court, abortion access in that state will be radically diminished. 

The study didn’t just look at who sought information about self-managed abortion. It also examined the reasons people gave for going that route. Nearly 75% of the people who sought medication abortions through Aid Access stated they were unable to afford an in-clinic abortion. Medication abortions in the clinic setting cost an average of $535. Going through Aid Access costs $105. 

Nearly 50% of the people who sought assistance through Aid Access stated they were afraid of a partner or family member finding out about their abortion if they had to go to a clinic for the procedure; 40% indicated that distance was a factor and that the nearest clinic was too far away, and nearly the same amount stated that they would have to take too much time off from work or school to get to a clinic. 

These myriad difficulties are the direct result of abortion restrictions. As clinics shutter, as bans pass, as obstacles like waiting periods and mandatory ultrasounds increase, more people will become unable to get an abortion. 

Self-managed medication abortion is a solution to this problem.  But because it requires people to enter into an arrangement that lacks formal legal protections, it’s an imperfect one.

A previous version of this story misidentified the researchers behind the May study published in “Obstetrics and Gynecology.”