A pilot program in Washington state allows pharmacists to prescribe abortion medication via telehealth. (Chris Coduto/Getty Images for UltraViolet)
Since the U.S. Supreme Court’s decision in 2022 to allow states to regulate abortion access, support for expanded access to abortion pills has significantly increased, including among those living in states with abortion bans, according to a new study from the Journal of the American Medical Association.
A sample of more than 7,000 women nationwide between the ages of 15 and 49 answered surveys in December 2021 prior to the Dobbs decision, and a random sampling of half the same population was surveyed again in June 2023 after the decision.
The surveys gauged support for two models of expanded access to medication abortion: advance provision — when medication is obtained before a pregnancy and reserved for future use if necessary — and over-the-counter access at a local pharmacy or other retailer without a prescription.
Those who favored both models increased from about 49% in 2021 to 55% in 2023, while those who were opposed dropped from about 35% to 32%.
“While it is unlikely that states with abortion bans would provide medication abortion in advance or sell it over the counter at retail pharmacies should the FDA approve it, these models may still improve abortion access for people living in such states,” the study authors said. “By expanding access to abortion to brick-and-mortar and/or online pharmacies and via telehealth in states with protected access to abortion, these alternatives would offer more options where people could travel … or receive the medications from friends or family members living in states with such access.”
The study also found a slight increase in the barriers the women faced to reproductive health care, including locating a clinic.
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Support grows
Led by Antonia Biggs, acting director of Advancing New Standards in Reproductive Health at the University of California, San Francisco, the study comes days before President-elect Donald Trump takes the oath of office for his second term, and Republicans now control Congress. Lawsuits are pending that could heavily restrict nationwide access to abortion medication, and possible restrictions could be made to mail distribution, a major point of access for people in at least a dozen states with near-total abortion bans. Anti-abortion groups have vowed to keep trying to revoke the U.S. Food and Drug Administration’s approval of the drug mifepristone, and have expressed their willingness to support Trump’s nominee to lead U.S. Health and Human Services, Robert F. Kennedy Jr., because of his hostile approach to pharmaceutical drugs and vaccines.
At the same time, states where abortion is broadly legal are working to expand access. Among the strategies are a pilot program in Washington state allowing pharmacists to prescribe the medication via telehealth and shield laws that prevent states with bans from attempting to obtain medical records or otherwise investigate instances of their residents seeking abortions in legal states.
Women generally support more access
Individuals can often receive abortion medication before a positive pregnancy test by ordering online, even in states where the procedure is banned, or in some cases through telehealth in a legal state. Mifepristone and misoprostol are not currently sold over the counter.
About 10% of the survey participants had a history of procedural or medication abortion. The remaining respondents had either never given birth or had never had an abortion. About 42% lived in a state with either a total ban or restrictions between six and 18 weeks of pregnancy.
The women were asked to give their personal interest in either model after it was described. A majority of respondents did not have a personal interest in obtaining abortion pills before getting pregnant, with about 26% saying they were definitely or probably interested, an increase of about 3%. But many more were personally open to over-the-counter access, with 42% saying they were definitely or probably interested.
“The (over the counter) model was particularly appealing among people experiencing marginalization from the health care system, including people living in states with total abortion bans, in nonurban areas, living in poverty, and those who experienced barriers to reproductive health care and medical mistreatment,” the study authors said. “Unlike the (advance provision) model, the OTC model may be particularly appealing for people who lack access to high-quality, nonjudgmental, and respectful health care because it does not require interaction with a clinician.”
More respondents report barriers post-Dobbs
Respondents also largely indicated that the barriers they experienced to reproductive health care had increased since 2021. The survey listed 10 potential barriers, including difficulty finding a clinic that offered services or accepted their insurance, finding a clinic where they felt comfortable, finding transportation, getting time off work, and getting to a clinic if a partner or family member didn’t want them to go. The number of women who said they faced three or more of those types of barriers to reproductive health care increased from 15% in 2021 to nearly 18% in 2023.
“Consistent with previous research, support for these models of care varied significantly by ideological perspectives, including political party affiliation and religion, with Catholics, Evangelicals, and Protestants reporting significantly lower yet increasing interest in an OTC model when compared with people reporting no religion,” the study said.
The work was funded by the Susan Thompson Buffett Foundation, the David and Lucile Packard Foundation, and the William and Flora Hewlett Foundation, but the funders had no role in the design or implementation of the study. English and Spanish speakers were eligible to take the survey, which was conducted online by a market research firm.
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