The Abortion Pill Remains Legal, but Women Have Been Stocking Up For Months

On June 13, the Supreme Court preserved access to medication abortion, unanimously rejecting a bid from anti-abortion doctors challenging the FDA’s approval of the drug. The ruling means it is currently legal to dispense abortion pills by mail in states where abortion is protected, though the medication is still illegal in states where abortion is restricted and reproductive freedoms remain in danger.

A study published in JAMA Internal Medicine in late March, just a day before the Supreme Court began hearing arguments on the case, found that abortions by pill increased drastically since Roe v. Wade was overturned in Dobbs v. Jackson in June 2022. In the six months following the Dobbs decision, the average of abortion pill orders at various telehealth organizations went up from 1,400 per month to 5,900 per month.

Back in January, we spoke to six women about why they were stockpiling their abortion pills as a means for security, in case they got pregnant.

Courtney, 27, learned about advance provision — a practice that involves ordering abortion pills as a precautionary measure — during a TikTok scroll. Once she found there were telehealth organizations safely shipping abortion pills to states with abortion bans, she sought her own supply. Living in Arkansas, where abortion is completely banned, paired with recently learning that she’d been taking a medication that made her birth control ineffective, Courtney requested advance-provision pills through Aid Access, a nonprofit providing access to medication abortion by mail.

“If I ever was in the position of being pregnant and wanting to terminate, I would have the option to decide that for myself in the comfort of my home,” says Courtney, who, like other people in this story, is being identified by her first name to protect her privacy.

Courtney is one of tens of thousands of women who weren’t pregnant but obtained abortion pills out of fear about the future of abortion access following the overturning of Roe v. Wade. Since the overturn, experts have said abortion pills are the future of abortion access — but the aforementioned Supreme Court case will determine whether the Biden administration can protect access to the pill.

To be clear, both abortion pills and ordering the medication online are “remarkably safe,” says Jennifer Lincoln, MD, an ob-gyn who sits on the board of directors at Mayday Health, a nonprofit that spreads awareness around accessing safe abortion pills in any state. “As a physician, I would feel as comfortable telling somebody that they can get abortion pills ahead of time as I would telling somebody to have ibuprofen in their cabinet before they have a headache or menstrual cramps.” In fact, Dr. Lincoln says she has her own supply of abortion pills in her medicine cabinet.

In January, JAMA Internal Medicine published a study that revealed an influx of advance provision requests after the Supreme Court decision was leaked in May 2022, and into 2023. It looked specifically at Aid Access, which received more than 42,000 advance provision requests following the landmark ruling. That was a massive increase compared to the estimated 6,000 requests received from September 2021 to May 2022. Request rates were high in states with abortion bans, and even higher in those where abortion access is threatened.

Aid Access is one of several trusted organizations that distribute pills from overseas. Once a request for advance provision is sent in, a provider based in the US will write a prescription for 1 mifepristone and 12 misoprostol tablets, which are taken in conjunction to end a pregnancy. The prescription is then shipped to the recipient by a partner organization within a few weeks. In Aid Access’s case, the service costs $150, but anyone unable to pay it is asked to donate what they can.

We spoke to several folks who ordered abortion pills for potential future use on what made them turn to advance provision and how they felt about having the medication on hand.

Preparing For the Worst in States With Abortion Bans

Despite continued attempts by states to ban medication abortion, it’s currently legal to dispense abortion pills by mail.

For Courtney, if not for advance provision, she knew her only option to safely access abortion would be to travel to the nearest clinic providing abortions, which is more than 300 miles away in Kansas. “When Roe v. Wade was overturned, I became very nervous about the future of my reproductive health care and my right to choose,” she says. “Growing up and living in the South, it also made me incredibly nervous and scared to even go to a hospital because of hearing about women who were arrested or went to jail because of a miscarriage or something they had no hand in causing [pre-Roe].”

Katie, 32, who resides in North Carolina — which has enacted a 12-week abortion ban — felt compelled to order advance-provision pills after reading about women in total ban states who were forced to carry high-risk pregnancies. One of the medications she takes for her chronic illnesses can cause serious birth defects, and while she has a birth control implant, she worries about potential accidents. “Who’s to say that the state government would recognize that if I got pregnant while those teratogenic effects were likely?” she says.

After talking to her boyfriend, they thought it made sense to get the medication just in case. “The unpredictability of the past few years only promises more unpredictability,” she says. “I don’t want to have to take them, and I support choice, but that doesn’t mean that deciding to keep or abort a pregnancy would be something I’d take lightly.”

Mary*, 35, lives in Indiana, which has already enforced a total ban on abortion. She thought she would order abortion pills while she could, concerned that continued restrictions and the threat of a nationwide abortion ban could prevent her from accessing them in the future. “I’m really not very confident in the way things are going politically so it was a ‘just in case’ measure,” she says.

Unpredictability in States With Abortion Access

Although Claire*, 38, lives in Kansas, where abortion is currently legal, she “didn’t know if or how the law would change in the future.” She ordered advance-provision pills the night the Supreme Court draft was leaked. “I didn’t want to wait because when the anti-abortion movement is motivated, they move quickly to box people in and cut off resources to healthcare,” she says. “I know this because I grew up going to Catholic school and received anti-abortion messages on a regular basis.”

She continues: “Kansas has reaffirmed its preference for abortion rights, but I still worried about going through an unwanted pregnancy, and the idea of going to a clinic with protesters shouting in my face was scary and unappealing.”

Living in New York City, where abortion is also legal, Sarah*, 30, made the decision to stock up on abortion medication for extra security. “I hope not to get pregnant, but if I were to, I want to be able to handle it quickly and eliminate the stress of locating abortion services,” she tells PS. “My access to abortion is not threatened, but having the pills on hand made me feel more secure in my decision to remain off birth control,” she says, explaining that she went off birth control after experiencing a severe spike in migraines.

Taking Precautions After Previous Abortions

Two women we spoke to had previously had abortions, and their past experiences only reaffirmed their desire to request advance-provision pills post-Roe.

About three years ago, Kim*, a 38-year-old living in Missouri, terminated a pregnancy at Planned Parenthood with a medical abortion. Looking back, she remembers she had to wait “weeks” after making the decision to get into the clinic to take the pills.

“Having an unwanted pregnancy is difficult enough and no woman wants to have to wait to take action,” she says. “Having to go to a clinic is a long, invasive, and traumatic experience in itself. Being able to make such a choice in the comfort of your home, as soon as possible, is a blessing. Hopefully I won’t need these [advance-provision] pills, but if I do, I won’t have to go through the stress and the panic of ‘figuring it out.'”

In her early 20s, Mary*, the 35-year-old living in Indiana, had a surgical abortion. At the time, she wasn’t presented with the option of medication abortion. Having experienced that in the past, now, she wanted to order abortion pills for peace of mind. (Indiana is a complete-ban state.) “It makes me feel relieved that if I do get pregnant when I’m not intending to, I have something right in my medicine cabinet that I can use safely,” she says.

Stocking Up, Despite Feeling “Greedy”

While some expressed concerns over taking away pills from those who might need them immediately, Dr. Lincoln assures there is currently no shortage of these medications. She adds that if there ever was, suppliers like Aid Access prioritize time-sensitive requests. “Get what you need and don’t feel guilty about it,” she says. “Don’t go overboard, but know that if there’s ever a time where a concern comes up about a shortage, we’ll get it out there and we’ll let you know. But for right now, we have far more pills than we can get into the hands of people.”

Katie, 32, still has her pills stored in a safe space at home in North Carolina, but she’s considered ordering another supply in case friends need to use them. “It makes me feel kind of greedy, but that’s a function of the pressures that politics is putting on our healthcare, not me,” she says. “I wish I didn’t have to have a secret pharmacy in my house.”

As Dr. Lincoln puts it: “We are in a war against people being able to do what we need to do with our bodies. And in wartime medicine, we have to adjust our standards. The reality is this is where we’re at.”

*Names have been changed