On June 24, 2022, the US Supreme Court decision in Dobbs v Jackson Women’s Health Organization overturned Roe v Wade, creating a patchwork of state abortion laws.1 We assessed changes in online telemedicine requests to self-manage abortions with medications before vs after this decision.
The nonprofit Aid Access2 is the only online telemedicine service providing self-managed medication abortion (abortion conducted outside the formal health care setting) in the US. We analyzed anonymized requests for medications to the service in 3 periods: baseline (September 1, 2021, to May 1, 2022); after the Dobbs decision was leaked but before its formal announcement (May 2 to June 23, 2022); and after Dobbs was formally announced (June 24 to August 31, 2022). We omitted requests for advance provision of medications before pregnancy occurred and requests from 20 states where Aid Access provides telemedicine abortion within the formal health care setting. We categorized the remaining states as follows: (1) 12 states that banned abortion following the decision (including 3 where bans were enjoined but then reinstated during the study period); (2) 5 states that implemented bans after 6 weeks’ gestation; (3) 10 states that did not enact bans but indicated that bans or restrictions are likely; and (4) 3 states with no current or planned legal changes.3 During each period, we examined the overall rate of requests and, for each state separately, the mean rate of requests per 100 000 female residents aged 15 to 44 years.4 All requestors shared the reasons for their request from a list of responses or using open-ended text. We examined changes in requestors’ stated reasons for accessing the service before and after the formal announcement.