By Julia Tasset, Klaira Lerma and Paul Blumenthal
Access to safe and legal abortion services is a fundamental aspect of reproductive health care and bodily autonomy. While medication abortion is safe and effective, pregnant people face mounting access barriers. In the United States (US), since the Dobbs v. Jackson Women’s Health Organization decision, 13 states have criminalized abortion and six have bans which would severely limit services under legal review. These policies will cause harm in numerous ways as access is now constrained, causing increased facility wait times and delays in care for both residents of states with and without abortion protections. Such delays are particularly detrimental for abortion care, for which earlier access results in better clinical outcomes and is preferred by those who seek abortion.
In an effort to create new avenues for access, advocates and clinicians have proposed a provider-administered, advanced provision model for abortion pills. This approach involves screening patients for ectopic pregnancy risk factors and contraindications to medication abortion, providing education about how to date a pregnancy by last menstrual period, and counseling about how to use the medication(s). Then, a prescription or the pills themselves are given with instructions for safe storage, medication expiration, as well as when and how to seek follow up care, if needed. Then, people have the tools to initiate a medication abortion without medical system gatekeeping under the time pressure of a newly recognized pregnancy. This approach draws on prior work demonstrating high acceptability and safety of de-medicalized models such as telemedicine and self-sourced, self-managed medication abortion [5–8].
While the concept of advanced provision medication abortion is promising, its functional performance has yet to be clarified in practice. Importantly, public interest in this option, especially in light of the changing legal climate for abortion, has not been well assessed. Thus, co-authors Lerma and Blumenthal undertook a comprehensive national, internet-based survey of the interest in advanced provision medication abortion in the United States, as well as perceived risks and benefits.
This work revealed the following key findings:
- High Interest: The study found that a significant proportion of potential users in the US expressed high interest in advance provision of abortion pills. This indicates that many individuals see value in having abortion pills on hand, offering them increased agency over their reproductive choices and decisions.
- Accessibility and Convenience: Among the primary reasons for the interest in advance provision of abortion pills were concerns about the potential barriers to accessing abortion care, such as restrictive legislation, geographical distance from abortion clinics, or the inability to schedule timely appointments.
- Privacy and Control: Advance provision of abortion pills empowers individuals to take control of their reproductive health discreetly and proactively. By having the medication readily available, users can avoid potential delays and maintain privacy during sensitive times.
Implications and Significance
Advance provision of abortion pills has the potential to address some of the existing barriers to abortion access, especially for individuals residing in areas with limited healthcare infrastructure. Moreover, it offers individuals a sense of control and autonomy over their reproductive decisions.
However, while advance provision of abortion pills has the potential to be a crucial addition to reproductive healthcare, it also raises questions about potential challenges and concerns. Ensuring the safe and appropriate use of medication abortion is of paramount importance, and healthcare providers would need to provide adequate information and support to users.
In conclusion, this article “Interest in Advance Provision of Abortion Pills: A National Survey of Potential Users in the USA” sheds light on an innovative approach to abortion care that has the potential to enhance reproductive autonomy for individuals across the country. Advance provision of abortion pills could also be a strategy employed in other settings outside of the US where timely access to abortion is constrained by law or health systems. By understanding the factors influencing interest in advance provision, healthcare providers and policymakers can work towards creating a more accessible and supportive reproductive healthcare system. As society progresses, it is crucial to prioritize individuals’ right to make informed choices about their reproductive health, and advance provision of abortion pills could be a crucial step in that direction.
Read the research paper here.
About the Authors
Julia Tasset MD, MPH
Dr. Julia Tasset is a fellow in Complex Family Planning at Oregon Health and Science University in Portland, Oregon. Her clinical and research interests include creating and strengthening pathways to access abortion care, contraception for medically complex people, and reforming clinical education.
Klaira Lerma, MPH
Klaira is a public health researcher currently based at the Population Research Center at the University of Texas at Austin. At the intersection of research, policy, and practice, her research interests include service delivery modifications that can increase access to and quality of care of abortion and contraception and examining disparities in access through a health equity lens.
Paul Blumenthal MD, MPH
Dr. Paul Blumenthal is a Professor of Obstetrics and Gynecology, Emeritus, at Stanford University. Across his vast career focused on sexual and reproductive health, he has published over 200 peer-reviewed publications involving collaborations from over 20 countries. Dr. Blumenthal is committed to the development and implementation of innovative approaches to reproductive health issues in both the domestic and international arenas.