Increased support for medication abortion reported after Dobbs

Increased support for medication abortion reported after Dobbs | Image Credit: © Carl - © Carl - stock.adobe.com.

There has been an increase in support for expanded access to medication abortion among people aged 15 to 49 years following the Dobbs v Jackson Women’s Health Organization (Dobbs) decision, according to a recent study published in JAMA Network Open.¹

Total or near abortion bans have been implemented across multiple states since the Supreme Court’s Dobbs decision in June 2022.² However, access to medication abortion through telehealth and online care models has increased since the FDA lifted the in-person dispensing requirement for mifepristone in April 2021.¹

According to investigators, advance provision (AP) and over-the-counter (OTC) access to medication abortion “have the potential to further increase access to abortion.” A 2017 survey indicated 44% and 37% of adult women supported AP and OTC access, respectively.

Two serial, cross-sectional, nationally representative online surveys were conducted to evaluate changes in AP and OTC support before and after the Dobbs decision. Participants included English or Spanish speaking individuals aged 15 to 49 years.

The pre-Dobbs survey was developed by testing previously published items about AP and OTC interest and support with a panel of individuals aged 25 to 45 years. Input about the study design was also provided by an advisory board.

The survey included an item asking ““Would you be interested in getting abortion pills [ahead of time from a doctor just in case?] and [over the counter from a pharmacy without a prescription if you were pregnant and didn’t want to be?]”

Responses included “definitely yes,” “probably yes,” “definitely no,” “probably no,” and “don’t know.” The former 2 responses indicated personal interest, while the latter 3 indicated being not interested.

Following this item, patients were asked if they would support the options being available for other individuals. Responses were measured on a similar 5-point Likert scale to the first question. Respondents were also asked to select advantages and disadvantages of AP and OTC models from a predefined list.

Outcomes were assessed based on sociodemographic characteristics. Relevant variables included race and ethnicity, age, gender and sexual minority status, language used to complete the survey, geographic region, living in a metropolitan statistical area, and living below the federal poverty level.

There were 10,543 respondents included in the final analysis, 31.3% of whom before Dobbs and 30.1% after Dobbs were aged 30 to 39 years. Hispanic race was reported in 21.3% and 21.4%, respectively, non-Hispanic Black in 13.7% and 13.6%, respectively, and non-Hispanic White in 54.6% and 54.2%, respectively.

Significant increases in support for AP and OTC and personal interest in AP and OTC were reported by year, from 48.9% to 55.1% and from 23.6% to 26.4%, respectively, for AP vs 49.4% to 51.1% and 36% to 42.5%, respectively, for OTC.

All of these rates also increased in adjusted analyses except for personal interest in AP. Support for AP increased from 50% to 54%, support for OTC from 50.4% to 54.4%, andpersonal interest in OTC from 36.9% to 41.5%.

Privacy was the most common advantage selected for AP and OTC, with rates of 53.3% and 44.3%, respectively. This was followed by convenience at 48.8% and 51.7%, respectively, and potential for earlier abortion access at 48.4% and 46.6%, respectively.

Non-Hispanic White patients, those living in the Midwest or in a state with a total abortion ban, affiliated with the Democratic political party, with no prior pregnancy, with other Christian religion, and with experience of ridicule from a health care provider had increased personal interest in AP. Increased personal interest in OTC was expressed in most population groups.

These results indicated increased national support and personal interest toward AP and OTC access to medication abortion among female individuals aged 15 to 49 years. Investigators concluded “policymakers and regulators should support and facilitate the research needed for the approval of an OTC product.”

References

1. Biggs MA, Schroeder R, Kaller S, Grossman D, Scott KA, Ralph LJ. Changes in support for advance provision and over-the-counter access to medication abortion. JAMA Netw Open. 2025;8(1):e2454767. doi:10.1001/jamanetworkopen.2024.54767
2. Aiken ARA, Starling JE, Scott JG, Gomperts R. Requests for self-managed medication abortion provided using online telemedicine in 30 US states before and after the Dobbs v Jackson Women's Health Organization decision. JAMA. 2022;328(17):1768-1770. doi:10.1001/jama.2022.18865