Rates of Self-Managed Abortion Outside the Healthcare System Surge as the Battle for Mifepristone Heats Up

March 28th, 2024

By Jill Drachenberg, Editor, Relias Media

After the U.S. Supreme Court overturned abortion rights in June 2022 in the Dobbs v. Jackson Women’s Health Organization case, several states scrambled to pass partial or full abortion bans. Many women have had to travel outside their home states to seek abortion care. Provision of abortion medication mifepristone via telehealth has eased some of that burden. In fact, mifepristone accounts for 63% of abortions within the formal healthcare system — a 53% increase from 2020. More than 642,000 took place in the year after Dobbs.

There also has been a steep increase in medication abortion obtained outside the formal healthcare system, according to the authors of a new study. Researchers studied the provision of mifepristone from telemedicine services with physicians outside of the United States (Aid Access), through community networks of volunteers, and online pharmacies overseas between March 1 to April 30, 2022 (pre-Dobbs), and July 1 to Dec. 31, 2022 (post-Dobbs). They found more than 26,000 doses of mifepristone were prescribed for self-managed abortions outside the healthcare system in the post-Dobbs period, more than four times the pre-Dobbs level.

“Our findings suggest that even though fewer people accessed abortion care within the formal health care setting in the six months after Dobbs, a substantial number were able to access abortion medications outside the formal healthcare setting, despite state-level bans and restrictions,” the researchers noted. “While self-managed medication abortion has long been considered a marginal practice in U.S., our findings suggest that this approach has become mainstream.”

Self-managed medication abortion is very safe and effective, according to researchers. Another recent study of medication abortion via telemedicine concluded 99.8% of these abortions were completed with no complications.

Both studies are especially significant as the Supreme Court considers whether the FDA erred in approving mifepristone in 2000. The decision could sharply curtail access to the drug, including the end of telemedicine provision. However, it seemed likely from oral arguments that the court would preserve access — not because of the drug itself, but because of standing. The justices seemed largely skeptical that the anti-abortion physicians seeking to reverse mifepristone’s approval were directly harmed by the FDA’s actions. “I think the difficulty here is that, at least to me, these affidavits do read more like the conscience objection is strictly to actually participating in the abortion to end the life of the embryo or fetus. And I don’t read either ... to say that they ever participated in that,” noted conservative Justice Amy Coney Barrett.

More coverage of the case and the anticipated decision will be available in upcoming issues of Contraceptive Technology Update.