Faced with growing legal restrictions and an uncertain future for reproductive rights, more people are turning to advance provision abortion pills as a proactive solution for autonomy, safety and peace of mind.
An increasing number of healthcare providers are prescribing abortion pills in advance of pregnancy, and many people are ordering these pills to have on hand in case they or a loved one needs them. Between September 2021 and April 2023, over 40,000 people ordered advance provision abortion pills. In one recent national survey, 65 percent of respondents said they would be interested in having these medications on hand. Advance provision abortion pills can significantly shorten the time between the decision to end a pregnancy and having an abortion. Growing legal restrictions on abortion and threats of even more restrictions once Trump is back in office have made this option more important than ever.
New research reveals women’s motivations for ordering abortion pills in advance, which include concerns about growing legal restrictions, a desire for a backup plan, the need to avoid health risks and taking back control in the face of looming abortion restrictions. The study was based on in-depth interviews with 39 people who ordered abortion pills in advance of needing them from the online telemedicine organization Aid Access between January 2022 and April 2023.
Many participants in the study expressed concerns about abortion restrictions as a reason to order abortion pills to have on hand. Most participants lived in a region with abortions bans and restrictions, but even those living in states supporting abortion rights expressed concern that the law could change in their state. “Frankly, I’m scared,” said 32-year-old Alexis from the Midwest. “I think there’s a loud minority of people who are doing things that are very damaging to people’s rights in this country. I needed to be proactive.”
Most of the participants overall were concerned about the quickly changing state of reproductive healthcare access and discussed concerns about the legality of abortion, contraception and in vitro fertilization where they, their friends and family lived.
Many wanted a backup plan and said having the medications on hand gave them peace of mind. “It makes me feel like I’m secure,” said 20-year-old Emily, who lives in the Southwest. “If anything was to go wrong today or tomorrow, I’m good. It’s like having insurance, full-coverage kind.”
The lead author of the study, Dr. Dana Johnson at the University of Wisconsin-Madison School of Medicine and Public Health, told Ms., “A lot of the folks talked about how having advanced provision made them feel okay because it took the pressure off. That just having this in their back pocket made the stakes of deciding when and how to be a parent a little bit turned down in the really stressful context after Dobbs.”
Others expressed concerns about their health and safety, and compared the medication to over-the-counter medications, first aid kits, fire extinguishers and cardiopulmonary resuscitation (CPR). A 37-year-old woman named Charlene, who lives in the Southeast and heard about advance provision on an abortion subreddit, explained: “I think of it almost like any other kind of medicine. I keep allergy pills in my medicine cabinet in case I need them. I’m not going to need them every day, but it might be something that I’ll need…like having Plan B, it’s just something that you have in case you need it.”
Several mothers in the study ordered the medications as a backup for their daughters. “Why wouldn’t you if you’re a mother?” said 48-year-old Lexi, who lives in the Southeast. “Why would you not have a fire extinguisher in your kitchen? You just would because fires happen. And pregnancy happens.” Another mother, 49-year-old Alice who lives in the Southeast, said, “To me, it’s like learning CPR. You’re never going to use CPR on yourself. You learn it because somebody else might need help.”
Two women ordered the medications and then had tubal ligations, but kept the pills on hand. One, 26-year-old Genevieve from the Midwest, said “I will not ever need to use them, but I would willingly give them to anyone that I knew that needed them and would order them again if I needed to.”
You don’t have to take them. You just have them on hand.
Bianca
Concerns about health risks that made pregnancy unsafe or extremely difficult were another motivation for ordering abortion pills in advance. “I have a lot of health problems, and I think it would be incredibly dangerous for me to have a pregnancy,” said Layla, a 35-year-old Midwesterner. “I just didn’t want to be in that situation if something came up.” Alexis explained: “If I were to have a baby or get pregnant, I would be considered a medium- to high-risk pregnancy just by virtue of having epilepsy…it’s possible to have a baby with epilepsy, but it is a factor in why I don’t think that that’s something I want to do. I don’t really want to deal with the stress of that and the potential complications.”
Several people actively trying to become pregnant wanted abortion pills on hand in case they experienced complications. “It’s a very scary time for us because we live in a state where abortion is heavily restricted,” said May, a 34-year-old Southerner. She and her husband had a likelihood of passing on a genetic disorder. “We want to have the power to build the family that we want and the family that we believe is right for us. If we were to get pregnant again naturally, and if we were to have really devastating test results, again, we would be very much alone in our state.”
Another woman, 41-year-old Mary-Anne who lives in the Southwest, said: “I wanted to have the option to terminate if I needed to or if I didn’t feel that my child was going to have a decent quality of life.”
A 20-year-old Midwestern woman named Bianca, who had a blood clotting disorder, worried a potential pregnancy would threaten her health: “I like to know that I have this in my hands and know that I can use it when and if I need to. … You have the choice to solve this problem yourself. You don’t have to take them. You just have them on hand.”
Some women expressed the desire to take back control of their lives that recent legal developments had threatened, as an act of resistance. “Having it at your home and readily available makes you feel safer and like more in control of what happens to you,” said Kylie.
Johnson said that participants were not concerned about using the medication, but they were aware of surveillance risks and potential legal risks. “My overall takeaway from the study is that people are very aware of abortion bans and they are very, very scared,” said Johnson. “Every single person we talked to talked about the abortion bans. They talked about their desire to prepare. People were very activated to do something about it.”
Researchers concluded that advance provision was a “strategy for securing abortion access despite restrictions,” and that “themes of autonomy, resistance and reassurance were woven throughout participants’ motivations.”
With a shelf life of about two years and a cost of between $25 to $150, advance provision abortion pills are ensuring access to medication abortion for many despite legal restrictions and can short circuit the medically-unnecessary obstacle course that currently exists in many states for people trying to access medication abortion.
“We hope that more people learn about other ways to access abortion care,” said Johnson. “I don’t think that advanced provision is a silver bullet. I don’t think that medication abortion or telehealth is a silver bullet for the crisis that’s happening. But I do think the more options and pathways to abortion we can put out into the world, the better.”
For information about how people are obtaining abortion pills in advance, see Plan C.
Telehealth services offering advance provision abortion pills include:
- Abuzz Health, $90-$150 (all states except TX, GA, AL, MS)
- Aid Access, $150 (all states)
- A Safe Choice, $150 (all states)
- The MAP, $250 (all states)
- We Take Care of Us, $150+ (all states)
- Women on Web, $120 (all states)
Online vendors also ship pills in advance.
