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Requests for abortion pills soar after Roe reversal, study finds

The five states with the largest increases per week were those that enacted total abortion bans: Alabama, Arkansas, Louisiana, Mississippi and Oklahoma.
An abortion rights advocate cries outside the Supreme Court after the court announced it had overturned Roe v. Wade on June 24.
An abortion rights advocate cries outside the Supreme Court after the court announced it had overturned Roe v. Wade on June 24.Frank Thorp V / NBC News

WASHINGTON — Requests for pills used to self-manage abortions rose significantly in 30 states after the Supreme Court overturned Roe v. Wade in June, according to a new study in the Journal of the American Medical Association.

In the study, published Tuesday, researchers examined requests residents of the 30 states made to the Austria-based nonprofit organization Aid Access, a physician-run service that mails abortion pills directly to people in the U.S.

Applicants provided at least one reason for needing the drugs, and many cited abortion restrictions that have swept the nation, the study said.

People seeking to end their pregnancies in those states have had few options. Traveling to states that offer abortion services might not be possible because of the expense or the difficulty in taking time off from work or finding child care.

The use of pills to induce medication abortions has increased in recent years amid laws enacted to limit access to reproductive services and the public health restrictions stemming from the Covid pandemic. Pills are less costly than clinical procedures, they can be taken at home, and they are safe for people to manage on their own, most doctors say.

Of the 30 mostly Republican-leaning states in the study, a dozen implemented total abortion bans after the high court's ruling in June, 10 didn't enact bans but had indicated that restrictions were likely, five implemented six-week abortion bans, and three had no legal changes or plans for them, the study said.

The researchers assessed requests made to Aid Access during three periods: before it was clear the Supreme Court planned to reverse Roe, after a draft of the decision was leaked and after the formal ruling was issued.

Over the course of the study, Aid Access received more than 42,000 requests for abortion pills from residents in the 30 states. During the initial period of the study, from September 2021 to this May, the nonprofit group got an average of about 83 requests a day. After the draft was leaked, from May to June 23, the average number of daily requests increased to about 137. After the Supreme Court released its opinion on June 24, the average of daily requests jumped to nearly 214.

"Every state, regardless of abortion policy, showed a higher request rate during the periods after the leak and after the formal decision announcement, with the largest increases observed in states enacting total bans," the study said.

The study found that the five states with the largest increases in the number of requests per week per 100,000 women were those that enacted total abortion bans: Alabama, Arkansas, Louisiana, Mississippi and Oklahoma.

That was similar to the increases that occurred after Texas enacted its near-total abortion ban last year and at the height of the pandemic in states where abortion services were suspended for several weeks, said Abigail R.A. Aiken, an associate professor of public affairs at the University of Texas at Austin, one of the study's authors.

"When you ban or severely restrict abortion, you don’t do anything to change the need for abortion, but you do change where people access care," Aiken said in an interview.

In states with total bans, the percentage of requesters who cited “current abortion restrictions” as a reason for using Aid Access doubled from 31% before the draft decision was leaked to 62% after the court's ruling.

"I think it’s strong evidence that people are reacting to these bans," Aiken said. "They’re having an impact on people, and people are saying, 'Well, I can’t get to a clinic anymore, so I’m going to have to find another way to do this.'"

Requests for abortion pills also rose in states where the legal status of abortion didn't immediately change, the study found, saying possible explanations included "increased awareness of the service, confusion about state laws, and disruption to in-clinic services following increases in out-of-state patients."

"Findings support prior research that limiting abortion within the formal health care setting is associated with more self-managed abortions," it said.

Aiken said: "It suggests that another, I think, unintended consequence and kind of ironic consequence of abortion bans is that they actually seem to draw attention to and illuminate the idea of a self-managed abortion. It actually opens up the idea of this different, other pathway — even in states where there’s no abortion ban."