Recently-enacted laws are making abortion health care harder and harder to get. As a result, more and more people are turning to the internet to find abortion health care.
As abortion restrictions increase, clinics close, and the cost of abortion goes up, women are increasingly ordering abortion pills online and taking them safely at home. One of the most reliable online options for abortion pills is Aid Access, founded by Amsterdam-based physician Rebecca Gomperts in 2018. A newly-released study reveals that 57,506 people from all 50 states requested the services of Aid Access in its first two years of operation.
“Even though we still have the right to abortion in this country, so many people struggle to actually exercise that right and access abortion,” said the study’s lead author, Dr. Abigail R. A. Aiken, associate professor at the University of Texas at Austin’s LBJ School of Public Affairs.
Recently-enacted laws are making abortion health care harder and harder to get, and more expensive. Restrictions include abortion bans, procedure bans, burdensome regulation of abortion clinics, requiring inaccurate or misleading counseling, ultrasounds or waiting periods before an abortion and medication abortion restrictions. As a result, more and more people are turning to the internet to find abortion health care.
“The rate of requests was increasing over the two years,” Aiken told Ms. “As more people are finding out about it, we are seeing the rate of request going up. As legislators make in-clinic abortion harder and harder to get, people are having to look for viable alternatives.”
Aid Access Forms To Meet A Need
Gomperts has for decades offered medication abortion services to women living in countries where abortion is illegal or inaccessible. In 1999, she founded Women on Waves, which offered medication abortion services on ships in international waters bordering countries where abortion was illegal. In 2005, she founded Women on Web, offering medication abortion services via the internet and shipping pills through the mail. Gomperts decided to form Aid Access in 2018 after Women on Web began receiving tons of requests for help from people from the U.S.
“Gomperts saw the real obstacle course that people in the United States were having to go through to access abortion,” Aiken told Ms. “She could see it was legal in name, but it was not legal in practice.”
Aid Access offers abortion pills to patients within the first 10 weeks of pregnancy. Individuals make requests to Aid Access by filling out an online consultation form. If patients live in Alaska, California, Connecticut, Idaho, Massachusetts, New Hampshire, New York, New Jersey, New Mexico, Nevada, Vermont and Washington, Aid Access refers patients to doctors in their state. These patients pay $150 and receive the medication within a few days. For patients living in the remaining states, European-based physicians review the consultation forms and provide medication to eligible patients via an India-based pharmacy that mails the pills within two weeks for a cost of $105. The Aid Access help desk is available to users at any time during and after an abortion.
Patients receive two medications—mifepristone and misoprostol—which, taken over a 24 hours period, induce a miscarriage and end a pregnancy. Mifepristone interrupts the flow of the hormone progesterone that sustains the pregnancy, and misoprostol causes contractions to expel the contents of the uterus. Today almost 60 percent of first trimester abortions occur with medications.
Abundant research has shown that medication abortion by telemedicine is highly effective and extremely safe. Medication abortion has a success rate over 95 percent and less than one-third of one percent (0.31 percent) of medication abortions result in serious adverse events. In fact, mifepristone is safer than Tylenol.
“These are two medications that we know are safe, we know they are effective, they have been around for a long time,” said Aiken. “Why is it not normal just to go and pick this up from a pharmacy or get them mailed by my doctor? People are starting to feel that.”
Factors Driving People to Aid Access
In the newly-released study, Gomperts, Aiken and another UT Austin researcher Jennifer Starling teamed up to analyze Aid Access data. They found that states with the most policy restrictions on in-clinic abortion had the highest rates of requests to Aid Access, such as Louisiana, Mississippi, Wyoming and Alabama. The lowest rates of self-managed abortions were in Vermont, Connecticut, Oregon and California.
“Our findings are clear: Requests for abortion pills via Aid Access for self-managed abortion are higher in states with more restrictive abortion laws,” Dr. Aiken told Ms. “As anti-abortion politicians attempt to ban abortion across the country, it’s not surprising that pregnant people are turning to safe and effective alternatives for abortion care.”
More surprising was the fact that requests came from all 50 states: “Though we saw the highest rate of requests from states that have the most restrictions on in-clinic abortion access, we did see requests coming from every state—even states that we would traditionally think of as quite accessible in terms of clinic access, like California and Oregon.”
Dr. Aiken attributed this ubiquity to the burdens inherent in medicalized abortion care: “Even if you live in a state where you don’t have to jump through a lot of state-mandated hoops to get an abortion, you still have to take time away from your job, or away from your family, or away from your other responsibilities.”
┏┓— NARAL (@NARAL) March 18, 2021
want medication abortion
To be easily accessible without medically unnecessary restrictions. #SafeButStillObstructed
The most common reasons people used the Aid Access services were their inability to afford in-clinic care (73.5 percent), a desire for privacy (49.3 percent), and clinic distance (40.4 percent). Other reasons given were that they were unable to take time away from work or school to go to a clinic (37.6 percent), that they would be more comfortable self-managing their abortion at home (28.2 percent), and that self-managed abortion would be more convenient (27 percent). About a quarter of respondents said they were self-managing their abortion because they didn’t want to deal with protesters outside of clinics.
“Cost and poverty are motivators when it comes to self-managed abortion,” says Aiken. “The more people who live in poverty in an area, the higher the rate of requests.” A 10 percent increase in the population living below the federal poverty level was significantly associated with a 20 percent increase in requests. States with restrictions on insurance and Medicaid abortion coverage tended to have higher baseline request rates.
“Cost and poverty are motivators when it comes to self-managed abortion. The more people who live in poverty in an area, the higher the rate of requests.”
Traveling long distances to clinics is particularly hard on those in poverty. Counties with high levels of poverty located far from an abortion clinic had the highest rates of Aid Access requests. An increase of 47 miles in distance to the nearest clinic was significantly associated with a 41 percent increase in requests. However, in places where individuals could not afford the cost of an in-clinic abortion, a shorter distance to a clinic was not associated with improved access.
People are positive about Aid Access, said Dr. Aiken, who has interviewed 80 people who have used service (this research will be out soon): “It’s a well-run service. It’s trustworthy. It’s run by people who actually care about the folks that they are trying to serve. It’s also affordable—entirely non-profit.”
Restrictions on medication abortion are dangerous and deepen health inequities that people of color and low-income communities face, especially during a pandemic. This can’t go on. https://t.co/k0CeJbzvlF— Planned Parenthood Action (@PPact) March 18, 2021
A Call to Action
As red states increasingly pass abortion bans and the Supreme Court is now reviewing a direct challenge to Roe v. Wade, Aid Access and other online providers of abortion pills are likely to play an increasingly important role in helping people access abortion.
“People are resilient and resourceful,” said Aiken. “They are going to find other ways. People have always found ways to get the abortion care they need.”
But Dr. Aiken’s research highlights the inequities people experience. “We already know that access to reproductive health care, including abortion, depends on where you live and how much money you make,” said Aiken, “but with our recent evidence showing strong associations between the distance to the nearest abortion clinic or living below the federal poverty level with higher rates of requests for abortion pills online, we can see that state bans are being layered upon structural inequities to restrict abortion access in our communities.”
Dr. Aiken calls on lawmakers to eliminate barriers to abortion health care in the United States. “As we fight for truly equitable access, we need state and federal legislation to address these barriers to in-clinic care and medication abortion pills.”