Seeking abortion medications
online can be a response to clinic access barriers in states with and without
restrictive abortion laws and can occur when self-managed abortion is preferred
over clinical care, according to new research from the LBJ School of Public
Affairs at The University of Texas at Austin. Researchers also found that
online options offer either information or medications, but not both, and lack
of trusted online options can delay care and lead to consideration of
ineffective or unsafe alternatives.
Abigail Aiken, an assistant professor of public affairs and a fellow of
the Richter Chair in Global Health Policy at the LBJ School, conducted
anonymous in-depth interviews with 32 people from 20 states who sought abortion
medications online. Results, which were peer-reviewed and published in
Perspectives on Sexual and Reproductive Health, provide insight into the
clinical and public health implications of the internet as a pathway to care.
"Though it may be surprising to consider, people in the United
States are looking for ways to end their pregnancies at home using abortionpills they can get online," Aiken said. "Someone might decide to
self-manage their own abortion either because of barriers to clinic access or
because it's a better fit for their circumstances."
The sample was composed of 30 women and two men, who sought abortion
medications online on behalf of their female partners. Participants' states of
residence were categorized in their policies toward abortion as "extremely
hostile," "hostile," "middle ground" or "supportive"
following the state abortion policy classifications developed by Elizabeth Nash
and colleagues at the Guttmacher Institute.
A major barrier for participants living in states with restrictive laws
was the high cost of clinical care. Other participants described major
logistical challenges resulting from state abortion laws, such as waiting
periods and ultrasound requirements. Logistical and financial difficulties
often intersected with concerns about harassment posed by clinic protesters.
Those living in states with middle-ground and supportive laws also experienced
access barriers, including long distances to clinics, lack of transportation
and difficulty finding information.
Whereas many participants cited access barriers as the reason they
considered ordering medications online, others explicitly preferred
self-managing their abortion to seeking care within the formal health care
setting. Underlying these preferences were the perceived advantages of
convenience, privacy and the comfort and familiarity of one's own home.
A key theme, regardless of participants' motivations for seeking
medication abortion online, was that the current options did not meet their
needs. Upon realizing telemedicine resources such as Women on the Web (WoW) and
safe2choose (s2c) do not serve the United States, almost all of the
participants also searched other sites. Most participants expressed concerns
about the legitimacy of online pharmacy sites.
"We know that medication abortion is extremely safe and effective
when carried out with the correct doses of medications, clear instructions and
information about what to expect, and a reliable source of support and
aftercare," Aiken said. "Unfortunately, most current online options
leave these needs unmet."
The lack of availability of trusted sources of abortion medications
online led some participants to research and consider options without strong
evidence of efficacy. These options included various supplements and
botanicals, as well as unsafe methods such as strenuous exercise, physical
trauma, use of sharp objects or ingestion of alcohol or household cleaning
substances.
"Our study shows that there is a public health justification to
ensure that people who do self-manage can do so safely," Aiken said.
The study was supported by a grant from the Society of Family Planning
and was supported in part by the Eunice Kennedy Shriver National Institute of
Child Health and Human Development.
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