As abortion access shrinks, people are stockpiling pills. But it's not always those who need it most

When the COVID-19 pandemic hit, people rushed to stockpile toilet paper, hand sanitizer and other goods. When the infant formula shortage happened, many parents hoarded what was left of baby formula in their local supermarkets. It shouldn't come as a surprise that in the wake of Roe v. Wade being overturned, many women in abortion ban states stockpiled on abortion pills.

In a research letter published in JAMA Internal Medicine, researchers looked at the data on requests for mifepristone and misoprostol from people who weren’t pregnant, but still seeking abortion pills from an online telemedicine service called Aid Access located in Europe. In the U.S., a medication abortion is usually prescribed when a woman is pregnant. However, the idea of a so-called “advance provision,” which is akin to keeping Tylenol around for a fever but instead keeping abortion pills nearby for pregnancy, has been discussed as a potential abortion care model in a post-Roe world.

According to the study, Aid Access received about 48,400 requests from across the U.S. between September 2021 and April 2023. Specifically, researchers found that requests were at their highest right after news leaked in May 2022 that the Supreme Court was set to overturn Roe v. Wade. Before the leak, the average number of daily requests was at 25. After the leak, requests increased nearly tenfold to 247 a day. In states where abortion bans were inevitable due to the ruling, the average weekly request rate increased ninefold.

When asked why people were ordering the pills, 74 percent of customers said "to ensure personal health and choice," and 73 percent said "to prepare for possible abortion restrictions." Taking a deeper look at who was requesting the pills, researchers found that white women made up 70 percent of Aid Access' advance provision requests and a majority of requests came from women who live at or above the national poverty rate. More requests also came from urban regions than rural ones. The average age was 27; notably, 74 percent of those who requested advance provisions did not have children. 

Researchers say that stockpiling is a normal response to a crisis. However, it can lead to artificial shortages and inflated costs, overall leading to less access to the treatment. Notably, the demographic data on who is stockpiling is at odds with the demographic data of who is most likely to get an abortion. While the typical abortion patient isn’t a monolith, data has found a patient is more likely to already be a parent and is below the poverty line. Could this trend of stockpiling among wealthier, white women have an adverse effect on access for marginalized groups?

Daniel Grossman, director of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California-San Francisco, told Salon via email he isn’t concerned that stockpiling could restrict access because there isn’t a shortage of mifepristone or misoprostol at the moment.

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“I’m not concerned that advance provision of these pills will reduce the supply for those needing medication abortion care,” he said, adding that he is nonetheless concerned for different reasons. “This care model is not yet reaching those who face the greatest barriers to abortion care.”

Grossman said more research is needed to understand why people of color and people living in low income areas are less likely to rely on advance provision.

“Is it that they don’t know about the service, can’t afford it, face barriers to using telemedicine, are ineligible or don’t prefer it?” he said. “My other concern about advance provision of abortion pills for people living in states with bans is the risk of criminalization.”

According to a report by the reproductive justice group If/When/How, 61 people in the U.S. between 2000 and 2020 were criminally investigated or arrested for allegedly ending their own pregnancies or helping someone else. David S. Cohen, a professor of law at Drexel Kline's School of Law, emphasized in a phone interview that the potential legal consequences like criminalization of stockpiling truly depends on the state a person resides. However, there is likely a common gray area. 

“A lot of state abortion laws require that someone has a diagnosable pregnancy and since there is no diagnosable pregnancy, you're not violating the abortion laws,” he said. In other words, stockpiling while not pregnant or distributing the pills to someone who you don’t know is pregnant could be a legal “loophole,” which Cohen used in quotes, in more restrictive states. “I put a loophole in quotes, because it's not a loophole, it’s the way the law is written, that you need to have a diagnosable pregnancy and if you don't, you're not violating the abortion laws.” 

Then there’s the idea that those who are stockpiling aren’t necessarily keeping it all for themselves, but instead could be distributors. However, depending on the state, that person could be held criminally responsible if they live in a state that specifically targets “providers.” 

“You would have to look at certain state laws around who's allowed to distribute medicine and I can't speak to those,” he said. “But they will not be violating the abortion laws unless they know that the person is pregnant, if that's the case for that state's law.”

Overall, Cohen and Grossman said they think advance provision could be an effective abortion care method in abortion-ban states for those who currently aren't relying on it.

“These pills are safe, they're effective, they are not complicated to use,” Cohen said. “There's plenty of information out there for people.”

Indeed, medication abortions are safe and effective. The process first requires taking a mifepristone pill, then a second pill containing misoprostol 24 to 48 hours later. Medication abortion works up to 70 days after the first day of a person's last period — usually when a person is 10 weeks pregnant. According to data from the Centers for Disease Control and Prevention, medication abortions account for an estimated 42 percent of all abortions in the United States. However, this spring, the Supreme Court is expected to hear a case that could block mail-order access to mifepristone and impose restrictions on its use.

Grossman said the biggest take away from this research is that there is “considerable demand for advance provision of medication abortion pills, especially in states with bans.”

“It highlights the need for more research to better understand why people of color and those living on low incomes are not yet accessing the service as much as would be expected,” he said.