A study published Monday in the medical journal JAMA found that the number of abortions involving pills purchased outside the official health system rose sharply in the six months after the nation’s right to abortion was repealed. Another report released last week by the Guttmacher Institute, a research organization that advocates for abortion rights, found that medication abortions now account for nearly two-thirds of all abortions performed by the country’s formal health care system which also includes clinics and telemedicine abortion services.
The JAMA study evaluated data from foreign telemedicine organizations, online retailers and volunteer networks that generally get their pills from outside the United States. Before Roe was overturned, these pathways provided abortion pills to about 1,400 women per month, but in the six months afterward, the average rose to 5,900 per month, the study said.
Overall, the study found that while the number of abortions in the formal health system fell by about 32,000 from July to December 2022, much of this decline was offset by about 26,000 medication abortions using pills provided by sources outside the formal health system.
“We’re seeing what we see elsewhere in the world in the United States – that when anti-abortion laws come into effect, people often look outside of formal health care and the locus of care shifts,” Dr. Abigail Aiken, an associate professor at the University of Texas at Austin and lead author of the JAMA study.
The co-authors were a statistics professor at the university; the founder of Aid Access, a European-based organization that pioneered telemedicine abortions in the United States; and a leader of Plan C, an organization that provides consumers with information about medication abortion. Before publication, the study went through the rigorous peer review process required by a major medical journal.
The telemedicine organizations involved in the study assessed potential patients using written medical questionnaires, wrote prescriptions from doctors typically located in Europe, and had pills shipped from pharmacies in India, generally charging around $100. Community networks typically asked for information about pregnancy and delivered or sent pills with detailed instructions, often free of charge.
Online retailers, which supplied a small percentage of the pills in the study and charged between $39 and $470, generally did not ask about women’s medical histories and shipped the pills with the least detailed instructions. The providers involved in the study were vetted by Plan C and found to be offering real abortion pills, Dr. Aiken.
The Guttmacher report, which focuses on the formal health care system, included data from clinics and telemedicine abortion services in the United States that performed abortions for patients who lived in or traveled to states with legal abortion between January and December 2023.
It found that 63 percent of those abortions were due to pills, up from 53 percent in 2020. The total number of abortions in the report topped one million for the first time in more than a decade.
Why this is important
Overall, the new reports suggest how quickly abortion provision has adapted in the face of post-Roe abortion bans in 14 states and strict restrictions in others.
The numbers may be an undercount and do not reflect recent Shift:Shield laws in six states that allow abortion providers to prescribe and ship pills to tens of thousands of women in states with bans without them having to travel. Since last summer, for example, Aid Access has stopped shipping medicines from overseas and operating outside the official health system; Instead, it ships pills out of the United States to states with bans under the protection of shield laws.
What’s next
In the case, which will be heard before the Supreme Court on Tuesday, the anti-abortion plaintiffs are suing the Food and Drug Administration in an effort to block or drastically block the availability of mifepristone, the first pill in the two-drug abortion procedure restrictive regime.
The JAMA study suggests that such a ruling could encourage more women to use options outside the official American health care system, such as pills from other countries.
“There are so many uncertainties about what will happen with the decision,” said Dr. Aiken.
She added: “It is possible that a Supreme Court decision in favor of the plaintiffs could have a domino effect as more people seek access outside of formal healthcare, either because they fear access will disappear or they have greater access Problems accessing medication.”
Source link
2024-03-25 15:05:05
www.nytimes.com
