LBJ School of Public Affairs, University of Texas at Austin.
Plan C, National Women's Health Network, Washington, DC.
JAMA. 2024 May 14;331(18):1558-1564. doi: 10.1001/jama.2024.4266.
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.
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.
Abortion restrictions following the Dobbs decision.
Provision and use of medications for a self-managed abortion.
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.
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.
最高法院在多布斯诉杰克逊妇女健康组织案中的裁决推翻了美国的堕胎选择权，随后至少有 16 个州实施了堕胎禁令或 6 周妊娠限制。先前的研究表明，在多布斯案之后的 6 个月内，美国正规医疗保健机构提供的堕胎手术减少了约 32360 例。然而，尚未研究非正规医疗保健机构提供的自我管理堕胎药物的供应趋势。
确定在多布斯案之后的 6 个月内，非正规医疗保健机构提供的自我管理堕胎药物是否增加。
设计、环境和参与者：使用 2022 年 3 月 1 日至 12 月 31 日期间向美国人民提供非正规医疗保健机构堕胎药物的来源（包括在线远程医疗组织、社区网络和在线供应商）的数据进行的横断面研究。我们使用分层贝叶斯模型从未提供数据的来源中推断缺失值。我们估计了多布斯裁决后自我管理堕胎药物供应的变化。然后，我们通过考虑到并非所有提供的药物都被接受者使用的可能性，估计了这些药物的实际使用情况。
多布斯裁决后的堕胎限制。
自我管理堕胎的药物供应和使用。
在多布斯案后的 6 个月期间（2022 年 7 月 1 日至 12 月 31 日），自我管理堕胎药物的总供应量增加了 27838 例（95%可信区间[CrI]，26374-29175），而不是基于多布斯案前水平的预期。排除推断数据的变化，结果只有轻微变化（27145；95%CrI，25747-28246）。考虑到药物未使用情况，实际的自我管理药物流产估计增加了 26055 例（95%CrI，24739-27245），而如果多布斯案的裁决没有发生，预计会增加 26055 例。
在多布斯案裁决后的 6 个月内，自我管理堕胎药物的供应有所增加。结果表明，尽管实施了州级禁令和限制，但仍有相当数量的堕胎寻求者获得了服务。
