When access to reproductive health care is threatened in the United States, a growing number of women stock up on abortion medications to keep on hand in case they need the pills in the future, new research shows.
A study analyzed 48,404 requests for “advance provision” abortion medications made to Aid Access, an Austria-based nonprofit offering telehealth abortion services in the US, between the beginning of September 2021 and the end of April 2023.
Most doctors in the US do not let patients order abortion pills before they’re pregnant. “It’s definitely something that’s never been standard practice here,” says Abigail Aiken, the principal investigator of the Self-Managed Abortion Needs Project (Project SANA) at the University of Texas at Austin, who led the study. In recent years, though, interest in “advance provision” has been on the rise, with a limited number of telehealth services giving patients the option to prepare in case abortion access is curtailed in their area.
Aiken’s study shows that demand for abortion pills made by women who weren’t yet pregnant spiked during events when reproductive health care access appeared under threat. This matters, because in 2024, the US will face its next big test for reproductive freedoms, when the US Supreme Court hears a case challenging access to mifepristone, one of the two drugs typically used in a medication abortion. If the court sides with the anti-abortion activists who brought the case against the US Food and Drug Administration, medication abortion access may be in jeopardy nationwide. With this potentially hazardous change on the horizon, it’s likely that even more people will start stocking up.
According to Aiken’s findings, requests were at their highest immediately following the Dobbs decision leak in May 2022, which signaled that Roe v. Wade would be overturned. From a baseline of around 24.8 requests a day, Aid Access saw an influx of 247.3 requests per day following the Dobbs leak. After this rush, requests jumped again after the Dobbs decision was finalized, averaging 89.1 per day. Most recently, requests rose once again, following conflicting court decisions in April 2023 regarding access to mifepristone, one of the two drugs commonly offered in the abortion pill protocol. Aid Access received an average of 172.1 per day.
“This is a way of taking back some control,” Aiken says. “Of being in control of your own reproductive destiny.”
One striking finding from this new research breaks down the type of people who are able to take advantage of advance provision. Compared with patients who request abortion pills for immediate use, patients who purchase abortion pills in case they become pregnant in the future tend to be significantly older, to live in low-poverty regions, and to not have any other children. They also tend, overwhelmingly, to be Caucasian. White women make up 70 percent of Aid Access' advance provision requests, compared to 39 percent of requests for abortion pills for immediate use.
This access gap demonstrates that there’s a need for more outreach, to ensure everyone who might need this medication can get ahold of it. “The potential of advance provision is amazing,” says Dana Northcraft, the founding director of the Reproductive Health Initiative for Telehealth Equity and Solutions. But she sees it as a limited tool right now. “It’s not going to be a panacea. I don’t think it will reach those who most need care, especially people of color and people struggling to make ends meet.”
“We can’t say for sure what these demographic differences are telling us, but one possibility is that there are barriers to advance provision for certain groups, including financial barriers,” Aiken says. One issue that will need to be addressed is cost. While services like Aid Access offer sliding scale options for people who are financially struggling, paying for medication that isn’t an immediate necessity can be harder to justify for people with limited resources. “If it’s between getting pills and paying rent—which we know it is for a lot of people—you might say yes if you need the pills right away, but it’s a different calculus for advance provision.”
These findings suggest that people who might greatly benefit from access to advance provision aren’t able to access the services, but this does not mean they don’t want the services. “We find that the people most interested and supportive of advance provision of medication abortion are those who face barriers accessing reproductive health care,” says Antonia Biggs, a social psychologist at Advancing New Standards in Reproductive Health (ANSIRH), a research program based at the University of California, San Francisco. “Thus, as barriers to care increase, as they are in the current policy context, we anticipate demand for advance provision to grow.”
