Demand for Medication Abortion Through Telehealth Before and After the Dobbs v. Jackson Supreme Court Decision in States Where Abortion Is Legal

Abstract

Objective: The provision of medication abortion through telehealth accounts for an increasing share of total abortions in the United States, offering a private and affordable option for patients in both restrictive and supportive states. This study compares demand for telehealth medication abortion before and after the U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization (Dobbs) in states where abortion access is protected, to understand how patients seeking care in supportive states may have been impacted by the landmark decision.

Methods: We compared the volume of patients receiving medication abortion from a U.S.-based telehealth service in 18 states, the sociodemographic characteristics of patients, and self-reported reasons for choosing telehealth before and after the Dobbs decision using electronic medical records from March 24, 2022-September 24, 2022. All states examined support legal access to abortion; results were stratified to compare two levels of protective abortion policies.

Results: A total of 6,296 patients received medication abortion through telehealth during the study period. Daily demand increased by 74%, from an average of 25.0 patients per day in the pre-Dobbs period to 43.4 patients per day post-Dobbs (difference 18.4; 95% confidence interval [15.4, 21.5]; p < .001). No sociodemographic differences were observed between patient populations before and after the Dobbs decision. Comfort and privacy were the most frequently selected reasons for choosing telehealth in both time periods. Concern over legal restrictions was more frequently cited after the Dobbs decision. A larger increase in demand (88%) was observed in states with fewer protections post-Dobbs compared with states with the most protective policies (68%) (p < .001).

Conclusions: Demand for telehealth medication abortion increased after the Dobbs decision in states where abortion remained legal. Telehealth provides an essential pathway to access safe and effective abortion care for a broad range of patients across different policy environments.