A comprehensive national study published in JAMA Network Open has documented a significant shift in public attitudes toward medication abortion access, revealing increased support for both advance provision (AP) and over-the-counter (OTC) models following the Supreme Court's Dobbs decision.
The cross-sectional survey, comparing responses from before Dobbs (December 2021-January 2022) and after (June-July 2023), analyzed data from 10,543 individuals assigned female at birth, aged 15 to 49 years. The research provides crucial insights into changing preferences for abortion care accessibility in a post-Roe landscape.
Shifting Landscape of Abortion Access
Since the Supreme Court's June 2022 decision eliminating federal abortion rights, 12 states have implemented total abortion bans, with additional states enforcing strict gestational limits. This restrictive environment has prompted increased interest in alternative access models for medication abortion.
The FDA's pandemic-era decision to allow mail-order dispensing of mifepristone has facilitated the growth of telehealth and online care models, creating new pathways for medication abortion access.
Key Findings and Demographics
The study revealed notable demographic patterns in support for expanded access. Among the respondents:
- Hispanic/Latinx (21.4%) and Black non-Hispanic/Latinx (13.6%) populations showed significant representation
- Support increased across multiple age groups, particularly ages 15-17, 30-39, and 40-49
- Democratic party affiliation correlated with stronger support
- Residents of states with total bans showed heightened interest in both AP and OTC options
Advantages and Concerns
Respondents identified several key benefits of AP and OTC access:
- Privacy (53.3% for AP, 44.3% for OTC)
- Convenience (48.8% for AP, 51.7% for OTC)
- Earlier pregnancy access (48.4% for AP, 46.6% for OTC)
Primary concerns included:
- Potential incorrect medication use (57.2% for AP, 53.7% for OTC)
- Unanswered pre-procedure questions (46.3% for AP, 47.1% for OTC)
- Risk of forced administration (46.7% for AP, 43.9% for OTC)
Impact on Marginalized Communities
The research highlighted particularly strong interest in OTC access among traditionally underserved populations, including:
- Residents of states with restrictive abortion laws
- Rural communities
- Individuals with limited access to reproductive healthcare
- Those with low or high incomes
Clinical and Policy Implications
The study's findings suggest a growing acceptance of autonomous models of abortion care, especially among younger generations. The researchers emphasize the need for policymakers and regulators to:
- Support research necessary for OTC product approval
- Develop policies ensuring insurance coverage for both AP and OTC options
- Address concerns about safe administration and access to medical support
While the study demonstrates clear trends toward increased support for expanded medication abortion access, researchers acknowledge limitations, including the challenge of definitively linking increased interest to the Dobbs decision alone.
