Provision of Medications for Self-Managed Abortion Before and After the Dobbs v Jackson Women's Health Organization Decision

JAMA. 2024 May 14;331(18):1558-1564. doi: 10.1001/jama.2024.4266.

Abstract

Importance: The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied.

Objective: To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs.

Design, setting, and participants: Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients.

Exposure: Abortion restrictions following the Dobbs decision.

Main outcomes and measures: Provision and use of medications for a self-managed abortion.

Results: In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred.

Conclusions and relevance: Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortifacient Agents* / supply & distribution
  • Abortifacient Agents* / therapeutic use
  • Abortion, Induced* / legislation & jurisprudence
  • Abortion, Induced* / methods
  • Abortion, Legal / legislation & jurisprudence
  • Abortion, Legal / methods
  • Cross-Sectional Studies
  • Female
  • Health Services Accessibility* / legislation & jurisprudence
  • Health Services Accessibility* / statistics & numerical data
  • Health Services Accessibility* / trends
  • Humans
  • Mifepristone / supply & distribution
  • Mifepristone / therapeutic use
  • Misoprostol / supply & distribution
  • Misoprostol / therapeutic use
  • Pregnancy
  • Self Care / methods
  • Self Care / trends
  • Supreme Court Decisions*
  • United States / epidemiology

Substances

  • Abortifacient Agents
  • Mifepristone
  • Misoprostol