Online Abortion Pill Orders Surged After Texas Ban. Researchers Say This Is Only the Beginning.

Self-managed medication abortion could help preserve reproductive autonomy in the event of a Roe v. Wade reversal this June, say researchers with the University of Texas.

“We definitely have a window on what the rest of the country may look like, especially in states where there are already trigger laws in place where abortion will be banned immediately or severely restricted if Roe is overturned,” says Dr. Abigail R. A. Aiken, one of the study’s authors. (Lorie Shaull and Robin Marty)

After the Supreme Court allowed the Texas six-week abortion ban SB 8 to go effect on September 1 last year, Austria-based telemedicine abortion provider Aid Access saw a sharp rise in Texans requesting abortion pills. New research published in the Journal of the American Medical Association shows that in the first week after SB 8 went into effect, average daily requests from Texas increased by almost twelve-fold, or 1,180 percent—from 10.8 to 137.7 per day.

In the following three months, requests remained higher than before, at 29.5 per month or 174 percent higher than before SB 8 went into effect. 

Medication abortion requests from Texas shot up the first week of September and remained higher until the end of the year. (JAMA Network)

“The fact that requests have increased so much—they’re more than triple the baseline in the post-SB8 period—tells us something about the gap that has been left by Senate Bill 8 and the uncertainty that it has created for people,” says 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. “Most people going to a clinic in Texas don’t know until they get their ultrasound whether or not they’re going to be told it’s too late under Senate Bill 8.”

Ordering abortion pills online through Aid Access may be a way to take control of the situation, says Aiken. “Some people may be thinking this is probably my most certain way of being able to do this, given that they might not be able to get out of state or given that they might not end up being eligible when they get to a clinic in Texas.”

Dutch physician Rebecca Gomperts founded Aid Access in 2018 to provide telemedicine abortion to people in all 50 US states, including the 19 states that currently prohibit telemedicine abortion. Dr. Gomperts provides an online consultation for people seeking abortion pills to make sure they are eligible and to provide information about how to use abortion pills. She then sends a prescription to a pharmacist in India, who ships the medications directly to people in the U.S.

The total cost is $150, but Gomperts offers a sliding scale fee for people who can’t afford to pay the full amount. She has served over 30,000 people in the U.S. since she began Aid Access four years ago. Aid Access services are physician supervised but considered self-managed abortion because they are outside of the formal U.S. healthcare system.

“The bottom line here is that this study provides us with pretty strong evidence that Senate Bill 8 was directly related to an increase in the need for self-managed abortion in Texas,” says Aiken. “Senate Bill 8 remains the strictest gestational limit on abortion anywhere in the United States. We know that there has been a decrease in the number of abortions within Texas clinics. A direct result of that has been that more people have been looking into the option of an abortion outside of the formal healthcare setting.”

Senate Bill 8 remains the strictest gestational limit on abortion anywhere in the United States.

Dr. Abigail R. A. Aiken

The number of abortions in Texas clinics dropped by over half between September of 2020 and 2021—from 4,511 to 2,164. But Aid Access received 1,831 requests for abortion pills from Texas in September 2021 alone. Aid Access requests in September equaled 78 percent of that month’s drop in the number of abortions due to SB 8. 

Even before the law went into effect, providers saw an uptick in abortion pill orders when in late March 2021 the Texas House passed SB 8. “The media coverage at the time talking about the consequences Senate Bill 8 might have caused people to worry that abortion was already limited at that time,” says Aiken.

People have found a range of creative ways to access abortion pills as states have passed increasingly restrictive abortion laws, including ordering from telemedicine abortion services in other states and ordering pills from online pharmacies as well as Aid Access.

“The self-managed medication abortion that Aid Access provides is only one in a spectrum of options to self-manage, but it’s probably one of the most widespread and most accessible option,” says Aiken, who notes in recent research that self-managed abortion with Aid Access is safe, effective and acceptable to people using it. “We can see here that self-managed abortion is filling a gap that has been left by the impacts of Senate Bill 8 on access to in clinic care.”

Interestingly, requests made to Aid Access increased not only in Texas but in other states as well. “It’s a smaller uptick than in Texas but follows a pretty similar pattern,” says Aiken. “We wondered if all this attention on SB 8 may have drawn the attention of people in other states to self-managed abortion and Aid Access. Even without a law as extreme as SB 8, abortion is extremely hard to access in many other U.S. states. It’s possible that people struggling to access care heard about Aid Access or self-managed abortion and then considered it a good option for them.”

Aid Access requests in the other 49 states resembled the Texas increases. (JAMA Network)

Aiken says increased awareness of abortion pills may also be leading to more people choosing to self-manage their abortions even when they have access to clinic-based care for reasons of affordability, privacy and convenience

“Self-managed abortion is the backup, second-string option for many, but for some people, it may be a preference. We know that from prior research. It may be something they’ve been unaware of previously, so knowing about it might mean that more people for whom it is a preference might choose it.”

We definitely have a window on what the rest of the country may look like, especially in states where there are already trigger laws in place where abortion will be banned immediately or severely restricted if Roe is overturned.

Dr. Abigail R. A. Aiken

As the Supreme Court appears poised to overturn Roe v. Wade and states pass abortion restrictions in unprecedented numbers, many people fear a return to the pre-Roe nightmare, when women suffered severe health consequences and even death from illegal abortions. Aiken says her research gives her hope that will not happen.

“I think we’re talking about a very different overall picture because of the accessibility of abortion pills and because of the model of care that Aid Access provides,” says Aiken. “In the pre-Roe period, hospital wards were full of people suffering terrible infections because of the effects of unsafe abortion. Self-managed medication abortion is a lot safer. And, thankfully, people are reporting it as something that is acceptable to them as an experience, which is also very important.”

Aiken says the last six months in Texas have shown us what could happen in other states in the future. “We definitely have a window on what the rest of the country may look like, especially in states where there are already trigger laws in place where abortion will be banned immediately or severely restricted if Roe is overturned. Just because you declare abortion to be illegal, the need for abortion is still there. People still need to find ways of accessing the care they need. It’s reassuring to think that we have a safe, effective and acceptable way for people to go ahead and access that care and preserve their reproductive autonomy.”

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About

Carrie N. Baker, J.D., Ph.D., is the Sylvia Dlugasch Bauman professor in the Program for the Study of Women and Gender at Smith College. She is a contributing editor at Ms. magazine. You can contact Dr. Baker at [email protected] or follow her on Twitter @CarrieNBaker.