番茄社区

Provision of medications for self-managed abortions increased in the 6 months after Dobbs v. Jackson Women's Health Organization, a cross-sectional study found.

In the July through December period after the decision was issued in June 2022, there were an additional 27,838 (95% credible interval [CrI] 26,374-29,175) provisions of medication for self-managed abortion compared with pre-Dobbs levels, and excluding imputed data only slightly changed the results (27,145, 95% CrI 25,747-28,246), reported Abigail R.A. Aiken, PhD, of the LBJ School of Public Affairs at the University of Texas at Austin, and colleagues.

Accounting for nonuse of some medications, the researchers estimated that an additional 26,055 (95% CrI 24,739-27,245) self-managed medication abortions occurred that wouldn't have if not for Dobbs, they wrote in .

Community networks accounted for 51.4% of all provisions, for 37.2%, and online vendors for 11.4%.

Previous research has shown an overall drop in abortions after the Dobbs decision overturned Roe v. Wade in June 2022. In the 6 months after Dobbs, an estimated 32,260 fewer abortions took place, according to the from the Society of Family Planning. This was expected, as traveling for abortion care can be expensive and logistically taxing. In the first half of 2023, the birth rate in states with abortion bans increased by 2.3% compared to states without total bans.

Ultimately, Aiken's group concluded that, despite fewer people accessing abortion from formal healthcare settings post-Dobbs, "a substantial number were able to access abortion medications outside the formal healthcare setting, despite state-level bans and restrictions," which suggests that self-managed medication abortions became more mainstream. The authors also cautioned that such individuals face unique legal risks and could have difficulty accessing post-abortion healthcare.

Caitlin Gerdts, PhD, MHS, vice president for research at Ibis Reproductive Health in San Francisco, who wasn't involved in the study, told 番茄社区 that it "draws attention to two things healthcare providers need to educate themselves about as more people self-manage abortions post-Dobbs" -- how to advise patients considering this option and "how to avoid actions that put patients at risk of criminal investigation for their pregnancy outcomes."

Gerdts emphasized that the estimated number of self-managed medication abortions is not an indicator that abortion bans cause no harm. "Abortion bans cause delays in care seeking, isolate pregnant people who need care, and criminalize those who support them in accessing the care they need," she said.

Self-managing a medication abortion involves taking misoprostol alone or in combination with mifepristone (Mifeprex). On Tuesday, the Supreme Court will hear oral arguments in the case FDA v. Alliance for Hippocratic Medicine (AHM) that will determine access to mifepristone.

Aiken's study was paired with two viewpoint articles that both urged the Supreme Court to rule in favor of the FDA and gave further context on the ramifications of potential rulings. One group led by Eve Espey, MD, MPH, University of New Mexico in Albuquerque, wrote that "a ruling against the FDA will push telemedicine abortion toward these informal online pathways, further stigmatizing a basic component of comprehensive healthcare."

In the other article, Holly Fernandez Lynch, JD, MBE, of the University of Pennsylvania in Philadelphia, and Aaron S. Kesselheim, MD, JD, MPH, of Harvard Medical School in Boston, wrote that "the Supreme Court should avoid inappropriate intrusion into FDA's public health mission by firmly rejecting efforts to second-guess the agency's scientifically supported approach to relaxing mifepristone restrictions."

Aiken's group analyzed data from March 1 to December 31, 2022, which was broken into two time periods: the pre-Dobbs baseline from March 1 to April 30 and the post-Dobbs time period from July 1 to Dec. 31. They analyzed provision volume data, which authors defined as the number of provisions of the abortion medications, from online telemedicine organizations, community networks, and online vendors. Eleven of the 15 unique sources (constituting most, if not all, active sources for self-managed abortion in the U.S.) provided data for the study, and the remaining four online vendors' data was estimated based on outbound clicks on their websites. For umbrella organizations, they aggregated data across subsources to avoid duplicates. Advance provision data was excluded and missing values were imputed.

To estimate actual use, authors multiplied the provision of medications by an assumed usage rate, which varied by source type. Based on preexisting data, the assumed use rate of medication obtained via telemedicine was 88%, via community networks was 98.5%, and from online vendors was 86%. The primary outcome was the provision and use of medications for self-managed abortion.

Aiken and colleagues noted several limitations, including that they were not able to cross-reference provisions across sources, which meant that some shipments from multiple sources could have been for the same person, although applying a use rate helped mitigate this problem. Plus, while sources excluded advance provision, not all asked about clinical history; and thus it's unknown whether provisions were for immediate or future use. Additionally, not all data sources kept formal records, and the authors therefore couldn't verify all data. Lastly, the authors could only obtain 2 months of pre-Dobbs data.

In the future, research should explore the relative contributions of service delivery models, they suggested.