Increased Interest in Advance Provision and Over-the-Counter Medication Abortion

An increased public interest and support for medication abortion following the federal Supreme Court ruling, particularly among marginalized groups, suggests a shift towards more accessible and autonomous models of abortion care. | Image Credit: Pakawadee - stock.adobe.com

Access to medication abortion has grown on a national level due to advance provision (AP) and over-the-counter medications (OTC), offering a promising approach to abortion care, especially for people living in abortion-restricted regions, according to a study published in JAMA Network Open.¹

The US Supreme Court eliminated the federal right to abortion in Dobbs v Jackson Women’s Health Organization on June 24, 2022, inciting total abortion bans across 12 states while others near.² Total abortion bans have been largely concentrated in Southern and Midwest states. An additional 6 states have gestational limits between 6 and 12 weeks of the last menstrual period, while 4 states have a gestational limit between 18 and 22 weeks.

Some states with abortion bans make exceptions for the pregnant person’s life, but others lack exceptions for life, rape, incest, or fatal fetal anomalies. Prior to the reversal of Dobbs, the FDA allowed for the continued mail-order dispensing of mifepristone due to the COVID-19 pandemic.³

The FDA’s decision has led to an increase in abortion medication access through telehealth and online care models that determine eligibility based on medical history.¹ The AP model allows patients to receive mifepristone and misoprostol medications before pregnancy from a clinician for later use. The OTC method utilizes individuals who could obtain the medications at a local pharmacy or other retailer without a prescription. Both options can reduce travel while ensuring earlier access to abortion care for people in states with and without bans.

“The current study sought to assess national changes in people’s interest and support for AP and OTC access to medication abortion between the periods shortly before and after Dobbs decision among a national sample of people who self-reported being assigned female at birth (AFAB), including young people,” study authors stated.

Researchers conducted a cross-sectional online survey that was nationally represented before Dobbs (December 2021 to January 2022) and after Dobbs (June to July 2023) for individuals between ages 15 to 49. Results found that 13,626 individuals AFAB completed the survey (n = 6841 in 2021-2022; n = 6785 in 2023). The final analytic sample included 10,543 (n = 6982 in 2021-2022; n = 3561 in 2023) observations.

Before and after Dobbs, 2666 and 1258 participants were between ages 30 and 39. Race/ethnicity before and after Dobbs were reported as Hispanic/Latinx (21.3% and 21.4%), Black non-Hispanic/Latinx (13.7% and 13.6%), and White non-Hispanic/Latinx (54.6% and 54.2%).

It is worth noting the support for AP and OTC, as well as personal interest among both, increased significantly by year in an unadjusted analysis. In an adjusted analysis, support for AP and OTC, along with personal interest in OTC increased largely by year. However, the personal interest in AP did not increase.

Popular advantages selected for AP and OTC were privacy (53.3% and 44.3%), convenience (48.8% and 51.7%), and potential to access abortion earlier in pregnancy (48.4% and 46.6%). Common disadvantages chosen for AP and OTC comprised of people that might take pills incorrectly (57.2% and 53.7%), unanswered questions prior to procedure (46.3% and 47.1%) and concerns that someone might be forced to take the pills without their consent (46.7% and 43.9%).

Increases in personal interest in AP consisted of population groups of non-Hispanic White race, those who live in the Midwest or a state with total abortion ban, Democratic political party affiliation, other Christian religion, had never been pregnant, and had experienced ridicule or humiliation from a health care practitioner. Individuals with a history of procedural abortion but no medication abortion were the only group to report a significant decline in personal interest in AP.

Several groups showed increased interest in OTC abortion pills, including:

* Hispanic/Latinx individuals

* Non-Hispanic White individuals

* Ages 15 to 17, 30 to 39, and 40 to 49

* Democrats

* Those with prior medication abortions

* Those with low or high incomes

* Residents of states with total bans

* Those outside the Northeast

* Those with limited reproductive health care access

Following the Dobbs decision, support for and interest in both AP and OTC medication abortion increased across various groups. Access to OTC was particularly appealing to marginalized populations, including those in restrictive states, rural areas, and those facing barriers to care.

Factors influencing support included political affiliation, religious beliefs, personal health history, and generational perspectives. Younger generations demonstrated greater interest in autonomous models of abortion care.

The increased use of medication abortion and online care models, coupled with the FDA's policy change, likely contributed to the growing public awareness and support for these options.

This cross-sectional study may not definitively link increased interest in OTC abortion pills to the Dobbs decision due to potential unmeasured factors. Survey questions may have been unclear regarding personal benefit, and results primarily reflect the perceived interest in these models of care.

Based on the increased interest and support of both AP and OTC access, “policymakers and regulators should support and facilitate the research needed for the approval of an OTC product, as well as prioritize policies that will ensure that both AP and OTC products are covered by insurance so that these approaches can become broadly available to the general public,” study authors concluded.

References

1. Biggs MA, Schroeder R, Kaller S, Grossman D, Scott KA, Ralph LJ. Changes in support for advance provision and over-the-counter access to medication abortion. JAMA Netw Open. 2025;8(1):e2454767. doi:10.1001/jamanetworkopen.2024.54767
2. Gomez I, Diep K, Felix M, Salganicoff A. 10 things to know about abortion access since the Dobbs decision. KFF. June 20, 2024. Accessed January 15, 2025. https://www.kff.org/policy-watch/10-things-to-know-about-abortion-access-since-the-dobbs-decision/
3. The FDA’s decision lifting the burdensome restriction on mifepristone during the pandemic: what you need to know. ACOG. April 21, 2021. Accessed January 15, 2025. https://www.acog.org/news/news-articles/2020/07/courts-order-lifting-burdensome-fda-restriction-what-you-need-to-know