Provision of Medications for Self-Managed Abortion Before and After the Dobbs v Jackson Women's Health Organization Decision.

Key Points: Question: To what extent has the provision of medications for self-managed abortion outside the formal US health care setting increased in the 6 months following the Dobbs v Jackson Women's Health Organization decision? Findings: In this cross-sectional US-wide study, the total number of provisions of medications for self-managed abortion increased by an estimated 27 838 in the 6 months after Dobbs (July-December 2022) vs what would have been expected based on pre-Dobbs levels. Meaning: Provision of medications for self-managed abortion in the US increased in the 6 months after Dobbs. A substantial number of people accessed abortion medications despite implementation of state-level bans and restrictions. Clinicians should be prepared to meet the needs of patients who may be considering self-managed medication abortion or who need or want to connect with the formal health care setting for postabortion care. Importance: The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied. Objective: To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs. Design, Setting, and Participants: Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients. Exposure: Abortion restrictions following the Dobbs decision. Main Outcomes and Measures: Provision and use of medications for a self-managed abortion. Results: In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred. Conclusions and Relevance: Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions. This study assesses whether the provision of medications for self-managed abortion outside the formal US health care setting increased during the 6 months after the Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US. [ABSTRACT FROM AUTHOR]