Demand For At-Home Abortion Pills Exploded During the Pandemic

In the first few weeks of the coronavirus pandemic, thousands of Americans sought out pills to end pregnancies on their own — without the help of an abortion clinic.

Between March 20 and April 11, Aid Access, an organization that ships abortion-inducing pills across the United States, saw a 27% spike in the rate of requests for the pills, a team of researchers led by the University of Texas at Austin found in a study released Tuesday. During that time period, Aid Access would normally expect to field about 2,638 requests for abortion-inducing pills. Instead, it received 3,343 requests.

The 11 states that saw what the team called “significant increase” in requests all tended to have either particularly high rates of COVID-19 — like New York and Washington state — or tried to use the coronavirus as a reason to impose restrictions on people’s ability to access abortions in clinics.

In Texas, where government officials successfully banned almost all abortions for a time, requests for abortions rose by nearly 94%.

“A doubling of requests is, I think, a significant finding, in a state that already has so many barriers to getting access to an in-clinic abortion,” said Abigail Aiken, assistant professor at the University of Texas at Austin and the lead researcher on the study. “Seeing it double in such a short time period was quite significant.”

But it wasn’t only legal restrictions on abortion that might have driven more people to seek help from Aid Access. The logistical hurdles of the pandemic also potentially played a role.

“I can understand being scared to go to a clinic. I can also understand being leery of taking public transport,” Aiken said. “I can also see people stuck at home with children that they can’t take to a clinic with them, you know, because you’re not allowed to bring anybody with you for all social distancing purposes.”

Aid Access, founded in 2018 by a Dutch physician named Rebecca Gomperts, lets Americans who are less than nine weeks pregnant undergo a medication abortion. Typically, Gomperts writes a patient a prescription for the drugs needed to induce a medication abortion, and a pharmacy in India mails the patient the drugs.

The organization is believed to be the most reliable organization shipping abortion-inducing pills to the United States. In 2018, more than 11,000 women consulted the service; Gomperts prescribed pills for more than 2,500 of them. (That number has since skyrocketed: Between January 2019 and April of this year, nearly 50,000 people requested help from Aid Access.)

The World Health Organization has determined that a patient who is less than 12 weeks pregnant can safely use these drugs without a physician’s direct supervision. Among abortion rights supporters, this practice is known as “self-managed abortion.”

The researchers calculate Aid Access’ “expected” number of requests in each state by designating the time between January 1, 2019, and the date of each state’s order to shut down businesses as the “before” period (in other words, before the coronavirus). They then used the number and frequency of requests in the “before” period to forecast just how many requests Aid Access would have received in the “after” period if the pandemic hadn’t struck.

The study doesn’t measure why, exactly, so many Americans turned to Aid Access. But at the height of the pandemic, government officials in 11 states tried to use the coronavirus and the need to conserve personal protective equipment as a reason to temporarily ban abortion, according to the Guttmacher Institute, which tracks abortion restrictions.

While reproductive rights activists sued, access to abortion flickered in Arkansas, Ohio, Tennessee, and Texas. Over the course of 19 days in Texas, volleys of litigation repeatedly lifted the abortion restrictions and then put them back into place — sometimes within a matter of hours.

In Ohio, requests for help from Aid Access rose by almost 22%, the study found. In Tennessee, they increased by more than 24%.

Researchers hadn’t intended to end their study after only a few weeks. But Aid Access had to temporarily halt its services, because it provides pills through a pharmacy in India — which shut down its international flights in late March. (Aid Access has since resumed services using pills procured through U.S. doctors.)

Since the study ended, however, one major restriction on abortion in the United States has been lifted. In mid-July, a judge ruled to temporarily suspend the Food and Drug Administration rules that had blocked doctors from remotely dispensing abortion-inducing drugs, citing the need to limit unnecessary travel and gatherings during the coronavirus pandemic. The ACLU had sued over the rules, arguing that they “singled out” abortion providers and patients “for a special barrier to telehealth care during the COVID-19 pandemic.”

But the judge said that his decision would not impact states that have their own laws that regulate access to medication abortion “above and beyond the FDA’s requirements.” Eighteen states require that an abortion provider be be physically present during the procedure, according to the Guttmacher Institute; these requirements could stop a patient from receiving pills remotely.

Now, with nearly 350,000 COVID-19 cases and more than 4,000 deaths, Texas is one of the new epicenters of the U.S. coronavirus outbreak. Given that Texas already tried to use the pandemic to cut off abortion access, Aiken fears what may happen next to people who want abortions.

“Sitting here in Texas, I’m looking at our situation and thinking we had the biggest increase in requests when the pandemic was emerging, and the response of Texas was to make it harder, right, was to take away access,” she said. “Changing state policy would allow for these services within the formal health care setting.”

Correction 7/22 5:33 pm ET: A previous version of this story incorrectly stated the period researchers gathered data from. The text has been updated.

Cover: Mifeprex is one of the drugs typically used to induce a medication abortion. (STORMI GREENER/Star Tribune via Getty Images)