Women living in states with more restrictive policies on abortion are turning to online sources for medications that can be used to induce the procedure, a study published Thursday found.
The study in the American Journal of Public Health examined data from a European online service called Women on Web. The service mails women early in their pregnancy two drugs — mifepristone and misoprostol — after a doctor reviews an online form filled out by the women.
The women can then take the pills at home, without having to go to a clinic or other abortion provider.
Over a period of 10 months — October 2017 to August 2018 — 6,022 people in the U.S. sought out Women on Web for access to the abortion pills, the study found. Of those, 76 percent were living in states with added restrictions on abortion, such as mandatory counseling and ultrasounds.
The highest demand was in Mississippi, Louisiana, Alabama, Tennessee and Texas, though requests came in from every state in the country — even those with the fewest restrictions, like New Hampshire. The only stipulation in that state is aimed at minors, who must notify a parent before having an abortion.
Reasons why women turned to an online source for abortion pills varied, but cost was a big factor.
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"We know that requiring people to come for two ultrasounds or have a waiting period makes the abortion cost more," said the study's lead author, Dr. Abigail Aiken, an assistant professor of public affairs at the University of Texas at Austin.
"In supportive states, the biggest barrier was fear of harassment by protesters," Aiken said.
A previous study by Aiken and her colleagues found that using medications to induce an abortion is as safe as going to a clinic, as long as the medications are taken early enough in pregnancy.
Mifepristone and misoprostol have been used since 1988 in some countries to induce early abortions. (Initially, the Women on Web program was meant only for women in countries where abortion was illegal, and as a result, didn't ship to the U.S. But that didn't stop American women from reaching out anyway.)
Women who use the drugs may experience side effects, though, such as pain, heavy bleeding and fever.
Experts say that's why it's critical women have access to doctors for information and follow-up care if needed.
"It’s important to think about the role other providers and clinics can play in supporting people who are accessing abortion medication online," said Megan Donovan, a senior policy manager at the Guttmacher Institute, which studies reproductive rights.
"We should always be pursuing policies that support a range of options for care," she told NBC News. "If you want to turn up to a clinic or to your doctor for abortion care, you should still be able to do that."
The Food and Drug Administration approved the use of abortion medication in 2000, and today it's used in up to a third of all abortions in the U.S.
However, FDA rules stipulate that the drug must be dispensed in clinics or a doctor's office. The FDA's website warns consumers against buying abortion pills online, saying "drugs purchased from foreign internet sources are not the FDA-approved versions of the drugs, and they are not subject to FDA-regulated manufacturing controls or FDA inspection of manufacturing facilities."
But the American College of Obstetricians and Gynecologists supports lifting barriers to accessing such medication, calling the FDA rules "outdated" because they "substantially limit access to this safe, effective medication."
Indeed, the new data illustrates how women seek to manage their own abortion care.
"Just because we restrict access and we put barriers in the way of people when it comes to abortion access," Aiken said, "it doesn’t mean people won’t find ways of having abortions."
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