Why Record Numbers of People Who Aren’t Pregnant Are Ordering Abortion Medication

Since the fall of Roe v. Wade in 2022, a growing number of people in the United States are buying abortion pills and keeping them on hand just in case they need them in the future. This process, referred to as advance provision of medication abortion, is part of an assortment of strategies providers are using to expand access to medication abortion pills. It’s also part of a legal gray area that abortion rights supporters are considering as an opportunity to expand abortion access. For abortion providers, more organizations are incorporating advance provision into their work. For policymakers, advance provision is notable to both anti-abortion and supportive lawmakers. Legal scholars have highlighted ways in which advance provision can expand access to medication abortion, as well as shift the legal approach to abortion. Some states have been removing the “known pregnancy” requirements since Dobbs, potentially making it easier to prosecute advance provision, missed period pills, and other alternative ways of dispensing medication abortion.

So, what do we know about how and why people are getting medications in advance? Researchers from the University of Texas at Austin found that tens of thousands of people are ordering these pills just in case they are faced with an unwanted pregnancy. Before May 2022, when a draft opinion of the Dobbs v. Jackson Women’s Health Organization Supreme Court decision was leaked, the online telemedicine organization Aid Access received more than 6,000 requests for advance provision. Following the leak, and subsequent opinion, Aid Access received more than 42,000 requests (averaging 118 per day) until April 30, 2023. Requests spiked even further after the conflicting court rulings on the Alliance for Hippocratic Medicine v. Food and Drug Administration case, which many people feared would limit access to the abortion medication mifepristone.

These are stunning numbers—clearly showing that when people are worried about policies and court rulings that will limit their right to abortion—they seek out other options.

But what are other reasons people might be ordering advance provision? To better understand what motivated people to order these pills, we conducted dozens of in-depth interviews with people who purchased pills in advance. The trend that people are concerned about current and pending abortion bans held true. This makes sense, as abortion is currently banned or substantially restricted in more than half of U.S. states, and due to these bans, more than 171,000 people traveled for abortion access last year. We also found that people were incredibly internet savvy as they tried to pull together a “backup” plan in case they lost access. They wanted to help friends and family. Some likened advance provision to having a fire extinguisher in your kitchen, or allergy meds in your bathroom.

But perhaps the most striking finding was that people were motivated to have a backup plan in case something went very very wrong.

People discussed that due to their health histories or other factors, they knew that pregnancy was either unsafe, or extremely difficult for them. Many of these same people were trying to get pregnant, but because of their health history they were cognizant of risks even a very wanted pregnancy may bring. This is reflective of a heightened awareness of pregnancy complications since Dobbs. In our sample, people with deeply wanted pregnancies, people who had undergone years of IVF treatments, were buying these pills just in case something went wrong. They bought these pills because they feared that if their pregnancy took a turn for the worse and an intervention had to be made, their state would deny them lifesaving abortion care.

And these concerns are far from unwarranted. Last spring the Supreme Court heard a case disputing whether states could decline to abide by the Emergency Medical Treatment and Labor Act, essentially determining whether doctors could allow their patients to bleed out in the ER, without intervening. Researchers have documented how abortion bans and the fear of bans are obstructing all kinds of clinical care. Journalists have written about how people are being airlifted by helicopters to receive care across state lines. Abortion bans have delayed emergency medical care for many pregnant people across the United States—and because of data delays, maternal mortality review committees are just starting to understand the toll Dobbs is taking on people. Recently ProPublica reported that in 2022, at least two women in Georgia died after they were denied legal, lifesaving abortion care. These women were healthy young women, with hopes, dreams, and families. Their deaths are the horrific consequence of abortion bans and a medical system that failed to provide emergency abortion care.

This is the United States after Dobbs. The U.S. right now is a constantly shifting landscape of abortion legality and reproductive health access. Our findings highlight advance provision as one way to navigate this new landscape, and potentially safeguard people from the harms of abortion bans.