As Uncertainty Looms, More People Request Advance Provision of Mifepristone
April 1, 2024
Interest in advance provision of abortion medications mifepristone and misoprostol has increased dramatically in the post-Roe era. It remains popular as a U.S. Supreme Court case looms over whether mifepristone should remain available.1,2
“We know medication abortion is very safe, whether under supervision of clinicians or self-managing at home,” says Klaira Lerma, MPH, research director of the Green Inequality Lab in the department of OB/GYN at the University of Wisconsin-Madison. “People prefer medication abortion over procedural abortion, and telemedicine access helps some people. Millions of people who are capable of pregnancy live in settings where abortion is illegal in this country.”
Advance provision is one tool to help expand access to the medication. “In any landscape, advance provision could be a safety net for people who need access to abortion,” Lerma says.
The National Abortion Federation (NAF) recently issued a new section on advance provision of medication abortion in the 2024 edition of its Clinical Policy Guidelines for Abortion Care.3 The guidelines state that providers can prescribe and dispense abortion medications for patients who are at risk of pregnancy for future use. The standards are to evaluate the patient, either in person or remotely, for eligibility and to inform them about the appropriate time to take medications with pregnancy dating. Providers also should inform patients of the efficacy, side effects, and risks of medication abortion and explain how to use the medications and to watch for symptoms of complications.
It also is recommended that providers encourage patients to contact them when they decide to use the medication and to offer a follow-up assessment. The report notes there is little evidence to show frequency of use or efficacy of advance provision.
Mifepristone Studies Retracted
The popularity of ordering abortion medication in advance is driven by recent abortion access changes in the United States. It started with the U.S. Supreme Court’s decision to overturn Roe v. Wade in June 2022.
Another change that led to a spike in interest occurred in 2023 when U.S. District Judge Matthew Kacsmaryk ruled mifepristone should be pulled off the shelves and that it was improperly approved by the Food and Drug Administration (FDA). Kacsmaryk’s 2023 ruling repeatedly cited studies questioning mifepristone’s safety — the same research that was retracted by the publisher in 2024.4
On Feb. 5, Sage Journals, which publishes Health Services Research and Managerial Epidemiology, announced that several articles about abortion, including two about mifepristone, were retracted because of undeclared conflicts of interest and a finding that the studies demonstrated a lack of scientific rigor that invalidates the authors’ conclusions. The studies’ authors declared no conflicts of interest, although several are affiliated with one of three organizations that advocate anti-abortion views and restrictions on mifepristone access. These include the Charlotte Lozier Institute, Elliot Institute, and American Association of Pro-Life Obstetricians and Gynecologists.5
Recent research shows how popular the notion of advance provision is among various demographic groups.1,2 For instance, Lerma and colleagues studied pregnancy-capable people’s interest in advance provision of abortion pills, finding those 18 to 24 years of age had the highest level of interest, followed by people 25 to 34 years of age.2 (For more information, see the story in this issue on advance provision research findings.)
“We conducted the survey before the Dobbs decision [January and February 2022], and we used social media advertisements to recruit folks,” Lerma explains. “We found 65% of people were interested, and most were young people, age 18 to 24 years.”
Court Decision Could Harm Youth
Young people, including teens, have the knowledge and capacity to consider what they would do and where they would go if they needed to seek abortion care, says Bianca A. Allison, MD, MPH, an assistant professor in the department of pediatrics at the University of North Carolina Chapel Hill School of Medicine. (More information on Allison’s study of adolescent awareness of the changing legal landscape of abortion will be available in the May 2024 issue of Contraceptive Technology Update.)
Youth younger than age 18 years also are knowledgeable about recent changes to abortion laws, Allison notes. “While legally, adult rights are typically granted at the age of 18 years, we found that minors’ knowledge was similar to that of young adults,” she says.
If the Supreme Court rolls back the FDA approval of mifepristone in whole or in part, such as rescinding its changes to permit remote prescribing and to approve it for pregnancies through 10 weeks instead of its initial approval for seven weeks, this dramatic change could most greatly affect young people — especially minors.
Youth living in abortion-ban states already face many obstacles to obtaining contraception and abortion care. Some states are passing laws that make it a crime for adults (other than guardians) to take minors out of state for abortion care. If youth can no longer obtain abortion medication via telehealth, or if mifepristone is banned entirely, that could end their access to safe abortion care.
Advance provision makes sense for young people if they fear being unable to obtain the medication later if they need it. Lerma’s study on interest in this method suggests that knowledge about advance provision and medication abortion is key to access. “A big conclusion that we have is information and knowledge are really important,” she says.
This includes staying knowledgeable about the ever-changing abortion-access landscape. “At the time I was working in Texas, even Texans would show up for [abortion] appointments and wouldn’t realize that if they were more than six weeks pregnant, they couldn’t get an abortion,” Lerma explains. “People were going into abortion clinics before they were closed and didn’t know what Dobbs was. It wasn’t in the public consciousness as much as it was later.”
Texas started with an abortion ban at six weeks with a law that allowed anyone, anywhere to sue an abortion provider. After Dobbs, the state passed additional laws to outright ban abortions at any stage of pregnancy.
REFERENCES
- Aiken ARA, Starling JE, van Blitterswijk DC, et al. Advance provision of mifepristone and misoprostol via online telemedicine in the US. JAMA Intern Med 2024;184:220-223.
- Lerma K, Blumenthal PD. Interest in advance provision of abortion pills: A national survey of potential users in the USA. BMJ Sex Reprod Health 2023;49:183-191.
- National Abortion Federation. 2024 Clinical Guidelines for Abortion Care. https://prochoice.org/provider...
- Simmons-Duffin S. Research at the heart of a federal case against the abortion pill has been retracted. NPR. Feb. 9, 2024. https://www.npr.org/sections/h...
- Sage Perspectives. A note from Sage on retractions in Health Services Research and Managerial Epidemiology. Feb. 5, 2024. https://perspectivesblog.sagep...
Interest in advance provision of abortion medications mifepristone and misoprostol has increased dramatically in the post-Roe era. It remains popular as a U.S. Supreme Court case looms over whether mifepristone should remain available. Advance provision is one tool to help expand access to the medication.
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