By Vishwadha Chander

(Reuters Health) – There’s demand among U.S. women for an online service offering abortion medication, and it’s driven mainly by restrictive abortion policies, but also by high costs, stigma or simply the appeal of a private, at-home solution, a small study suggests.

At the time the study was done, the U.S did not have online access to abortion care, researchers note in the American Journal of Public Health.

But a Netherlands-based non-profit that ships two WHO-recommended abortion pills to women in countries with no legal access to safe medical abortion was getting inquiries from U.S. women and began tracking the requests.

Analyzing information about these contacts over the course of 10 months, researchers found “real demand for medication abortion through online telemedicine services,” said Abigail R.A. Aiken of the University of Texas, Austin.

While the Netherlands-based organization Women on Web (WoW) does not provide medication to the U.S., it began keeping records of requests from U.S. women and the information they provided about why they were seeking abortion medication from an online source.

Aiken’s team – which includes the founder and director of the Women on the Web International Foundation in Amsterdam – analyzed the responses of U.S. women who contacted WoW between mid-October 2017 and mid-August 2018.

Over that period, WoW received 6,022 requests from the U.S. alone, and 76% of these were from states with restrictive abortion laws, the researchers found.

“What’s interesting is, even in states with restrictions, people were finding creative ways to overcome them online,” Aiken said in a phone interview.

Just over half of the U.S. women who requested the online service were ages 20 ti 29, and 21% were younger than 20.

Mississippi had the highest rate of requests, followed by Louisiana, Alabama, Tennessee and Texas.

In 2017, nearly all Mississippi counties had no clinics that provided abortion, Aiken’s team notes.

The fewest requests came from New Hampshire, Oregon, Minnesota, California and Maine.

“It’s not surprising that an online service shipping abortion pills to your door is attractive to women in states that have been doing whatever they can to make it difficult to get to clinics,” said Megan Donovan, a senior policy manager at the Guttmacher Institute in Washington, D.C., who wasn’t involved in the study.

Many women cited barriers to clinic access and a preference for self-management as reasons for seeking online services.

In states with hostile abortion policies, 71% of women said the cost of abortion made them choose an online service, compared to 63% in supportive states.

Legal restrictions and protestors outside abortion clinics were other common reasons given in hostile states.

The need to keep an abortion secret was a slightly more common reason among women living in supportive states.

The most surprising finding, according to Aiken, was that self-management was a preference. “The biggest factor underlying that preference was privacy,” she said.

The study showed the public health implications of restrictive laws such as mandated waiting periods, compulsory sonograms or stigma, the authors said in their report.

“State lawmakers hostile to abortion have enacted more than 475 restrictions since January 2011,” Donovan noted.

The study cannot clearly capture all demand for abortion medications from online sources because women may turn to online pharmacies or other methods that do not involve medications, the study team writes.

“But, we show the need to develop more innovative models of care. There never will be just one way in which people wish to access abortion,” Aiken said.

After the study period ended, an online telemedicine service called AidAccess had started providing medication abortion to women in the U.S., the authors note.

In an “ideal world,” Donovan said, people would be able to make choices and access abortion care free from stigma and medically unnecessary restrictions. “Self-managed abortion would be one choice alongside a full range of safe and effective options, but unfortunately, that’s not the world we live in.”

SOURCE: American Journal of Public Health, online October 17, 2019.