Imagine a world where you can find abortion pills on the pharmacy or grocery store shelf next to condoms and pregnancy tests and buy them without a prescription. A new study by researchers at Advancing New Standards in Reproductive Health (ANSIRH) found that pregnant people seeking abortion care were overwhelmingly interested in having over-the-counter (OTC) access to medication abortion.
The researchers surveyed 1,687 pregnant people seeking abortion care at seven abortion clinics in six states (Alabama, California, Florida, Illinois, North Dakota and Texas) between October 2019 and March 2020. They proposed a scenario where people could buy abortion pills legally without a prescription. The pills would come with detailed information about how to take them and a 24-hour telephone number to call with questions. You could ask a pharmacist any questions you might have and you could go to a clinic afterwards to make sure the abortion was successful.
“Our research finds that people are really interested and supportive of an over-the-counter model of abortion care,” said lead author of the study Dr. M. Antonia Biggs, associate professor at ANSIRH. “They perceive it to have the advantages of being safe, convenient, affordable and private.”
The survey found that 83 percent of abortion patients were in favor of over-the-counter medication abortion, a significantly larger proportion than the 37 percent reported in a 2017 nationally representative survey. Participants highlighted several advantages of over-the-counter medication abortion, including privacy (69 percent), earlier access to care (69 percent) and convenience (65 percent).
“There are many restrictions on abortion in general,” said Biggs. “People often live far away from clinics. If you had over-the-counter access without a prescription, you could go to any pharmacy. Most people live near a pharmacy. Many said that they thought it would also be more private and more convenient. They prefer to have an option where they could manage their abortion on their own at home.”
Cost was also an important factor for respondents, says Biggs. The average cost of in-clinic medication abortion in the United States is about $500, while the medications themselves cost less than $100.
“People are really in need of an affordable option,” said Biggs. “It’s very likely that over-the-counter medication abortion would be cheaper than an in-person option, particularly if it’s covered by insurance. At the very least, it would reduce the cost of travel to clinics that are often many miles away. People have to take time off of work, get childcare, stay overnight in a hotel. The out-of-pocket costs could have the potential to be lower. We found that the people who were most interested were those who had experienced financial barriers accessing care.”
Biggs hopes that the FDA will one day approve over-the-counter access to abortion pills, but emphasizes that insurance coverage for the medications would be critical.
“What will be really important as we move forward is to ensure that people can have affordable access to this option, and that it be covered by insurance—that it doesn’t leave people out. Affordability is really critical to increasing access to abortion.”
Research on demand is a required step in the process of making medication abortion available over the counter.
“There are a series of studies that are expected by the FDA in order to make that switch. And one of the important pieces of the research is to demonstrate that there is interest,” said Biggs, who noted the next step in the research—a label comprehension study—was already underway.
Previous research has shown that clinician support for a less medicalized model of medication abortion—without ultrasounds or blood tests—has increased in response to a strong safety record for abortion pills as well as the rise of telemedicine during the COVID-19 pandemic. One provider noted that “COVID-19 greased the wheels” for change to less medicalized abortion pill protocols.
The FDA recently lifted some restrictions on the abortion pill mifepristone—making telemedicine abortion possible—but left other restrictions in place. Nevertheless, Biggs and her colleagues at ANSIRH hope the FDA will one day approve over-the-counter access to abortion pills.
“You have to be visionary,” said Biggs. “I don’t know when it will happen. But we have the research to show that it’s safe. The more evidence we have, the more likely it is that we’re going to make a change.”
Sign and share Ms.’s relaunched “We Have Had Abortions” petition—whether you yourself have had an abortion, or simply stand in solidarity with those who have—to let the Supreme Court, Congress and the White House know: We will not give up the right to safe, legal, accessible abortion.