These Are the 10 States Where Online Abortion Drug Service Was Most in Demand

Women in states with restrictive abortion laws are more likely to seek out medication online to terminate pregnancies, a study has revealed.

Researchers looked at thousands of requests made to a non-profit online abortion service in a 10-month period to see where medication was most in demand, and why.

Between October 15, 2017 and August 15, 2018, U.S. residents made 6,022 inquiries to Women on the Web (WOW), which is based in The Netherlands. After an online consultation, WOW staff link women up with a licensed doctor, and post them mifepristone and misoprostol abortion pills in return for a donation of between €70 to €90 ($79 to $101), depending on where they live and their economic circumstances.

To qualify, users must be less than 10 weeks pregnant and have no illnesses. They must also live in a country where safe access to abortion is restricted, meaning WOW isn't available to U.S. residents. Instead, women are pointed towards relevant services in their area.

Just over three quarters, or 76 percent, of those who asked to be sent medication came from states with what the authors described as "hostile" abortion policies, having between four to 10 restrictions on the procedure. Only 24 percent of requests came from supportive states, which had three or fewer barriers to access.

The research, published in the American Journal of Public Health, showed there was the most interest in Mississippi, at 24.9 per 100,000 women of reproductive age during the time of the study, followed by Louisiana, Alabama, Tennessee and Texas.

Those in hostile states were more likely to say cost, distance, legal restrictions and the potential of encountering protesters put them off having an abortion the regular way.

Of the total, 71 percent of women in hostile states and 63 percent in supportive states said they tried to use WOW because they couldn't afford to visit a healthcare provider. A further 60 percent of users across all regions said they were unable to access a clinic and preferred to self-manage the condition. Some 49 percent said they wanted privacy.

Density of requests per 100,000 for abortion medications to women on web by state of residence in the U.S., between October 15, 2017 and August 15, 2018

Mississippi24.8
Louisiana21.3
Alabama17.3
Tennessee14.6
Texas14.4
Kentucky14.3
Arkansas14.2
Nevada14.1
South Carolina14.1
South Dakota13.9

The study also shed light on demographics, with over half the women already having children, 52 percent aged between 20 and 29 years old, and 21 percent younger. Some 72 percent were less than 7 weeks pregnant. A total of 45 percent fell pregnant after contraceptives failed, and 49 percent because they didn't use any at all. Five percent were raped.

Asked why they wanted to end their pregnancy, 69 percent of respondents said they didn't feel able to have their first or another child at the time, with 61 percent saying they couldn't afford it.

The authors acknowledged their research doesn't present the whole picture, as some people may buy drugs from online pharmacies, or use alternative methods. Those who visited the website but didn't fill in the consultation form were also not included in the data, they pointed out.

The research was carried out after a spike in anti-abortion legislation, and a drop in patients accessing the procedure, the authors explained.

Between January 2011 and mid-July 2016, state legislatures enacted 334 laws cracking down on abortion. In recent months, U.S. states have passed anti-abortion bills that are seen as an attempt to see the Supreme Court overturn Roe v. Wade. The landmark 1973 legal decision enshrined the right to safe and legal access abortion in the U.S. Constitution, and was followed by a drop in deaths linked to the treatment.

Lead author Abigail Aiken, assistant professor of public affairs at the LBJ School of Public Affairs at The University of Texas at Austin, commented in a statement: "These results suggest that state policies restricting access to abortion have made it harder for some people to access care in the clinic setting, and so they look online for alternatives."

Dr. Daniel Grossman, professor in the department of Obstetrics, Gynecology and Reproductive Sciences at University of California, San Francisco, who was not involved in the research, highlighted to Newsweek that the study is the biggest ever of U.S. women seeking abortion pills online, and "provides important details about who these people are."

The fact that people in hostile and supportive states gave similar reasons for seeking the pills "highlights that even individuals living in states with supportive policies may also face barriers accessing care," he said.

Critiquing the study, he continued: "The study looks at people requesting abortion pills online rather than those who actually ordered or obtained such medication. It also includes data from only one online site, and there are many providing these drugs.

"Finally, it may be that online searches for abortion pills increased in 2019 with the passage of even more restrictive laws in many states, although none of the abortion bans have gone into effect."

Commenting on the landscape of abortion services in the U.S., Dr. Grossman said: "Self-induced or self-managed abortion definitely still happens in the U.S., but it's not with coat hangers. Instead, many women use safe and effective medications. While self-managed abortion with pills is generally safe, some people may be forced to do this because the barriers accessing clinic-based care are too great."

Last month, bodies representing obstetricians and gynecologists warned in an editorial published in The New England Journal of Medicine that scores of women could die or be irreversibly harmed if Roe v. Wade is overturned in the Supreme Court.

The signatories of the article entitled The Dangerous Threat to Roe v. Wade said: "Some of us are old enough to have witnessed first-hand the consequences of illegal abortions performed by unskilled providers under nonsterile conditions; the rest of us have learned those lessons from history."

This article has been updated with comment from Daniel Grossman.

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Researchers have looked at the relationship between abortion laws and the sale of drugs to terminate pregnancies in the U.S.. In this stock image, a woman holds pills in her hand. Getty
These Are the 10 States Where Online Abortion Drug Service Was Most in Demand | Health