In post-Roe world, many seeking information on medication abortion, study finds

Use of a two-drug combination now make up over half of all abortions in the United States, according to the Guttmacher Institute, an abortion research organization. About 350,000 Google searches using those terms or "abortion pill" were conducted during the week of May 1 to 8, according to the authors of the new research letter. That first week in May is when the Supreme Court's decision that would overturn Roe v. Wade was leaked and widely reported.

Mifepristone (Mifeprex) and Misoprostol, the two drugs used in a medication abortion, are seen at the Women's Reproductive Clinic, which provides legal medication abortion services, in Santa Teresa, New Mexico, on June 17, 2022.
Robyn Beck / AFP / TNS
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ROCHESTER, Minn. —States expected to impose restrictions on abortion saw the biggest spike in Google searches seeking information on abortion medications.

The finding, reported in a research letter published on Wednesday, June 29, in the medical journal JAMA Internal Medicine, reflects a growing regional significance, post-Roe v. Wade, of FDA-approved drug cocktails that allow a woman to self-manage the termination of a pregnancy without visiting a doctor's office.

Use of the medications, a two-drug combination regulated as mifepristone (brand name Mifeprex), and misoprostol (brand name Cytotec), now make up over half of all abortions in the United States, according to the Guttmacher Institute, an abortion research organization.

About 350,000 Google searches using those terms or "abortion pill" were conducted during the week of May 1 to 8, according to the authors of the new research letter. That first week in May is when the Supreme Court's decision that would overturn Roe v. Wade was leaked and widely reported.

An hourly analysis conducted by the authors of that letter showed the spike in searches was "immediate," with the greatest concentration correlated to a state's letter grade on a reproductive rights index.


Nebraska, Iowa and Missouri topped the list of states showing highest abortion medication search activity.

Regionally, the study found South Dakota — which had been given an F for reproductive rights on the rankings used for comparison purposes — had a Google-issued relative search volume of 40 on a scale of 100. That put South Dakota in a three-way tie with Kansas and Kentucky for eighth-highest abortion pill search activity nationally.

The search activity spike in abortion medication interest was lower in North Dakota, whose surge was 34 nationally, while Minnesota came in at 37th out of 50 states. The authors concluded that "elevated interest in abortion medications should alert physicians that many of their patients may pursue this option with or without them."

FDA: Abortion pills safe, effective without a doctor's office exam

Since their approval in 2000, use of the medications, which cost $535 on average according to the Kaiser Family Foundation and which are considered safe and effective by the FDA when dispensed by a qualified professional in the first 10 weeks of pregnancy, were to be taken only after a office visit that included an ultrasound and pelvic exam.

Those in-office restrictions were meant to address concerns that a pregnant person was not beyond 10 weeks pregnant — and therefore less likely to have a successful termination — as well as that an ectopic pregnancy could be missed by use of abortion medications without an ultrasound.

The evidence for those restrictions was found to be lacking, however, after researchers earlier this year reported the results of a medical history-only abortion pill screening model adopted during COVID-related limits on in-person health care visits.

After reviewing outcomes for 3,800-patients over a 12-month period of study, a research group that included Planned Parenthood North Central States reported that the medical history-only patients had a 95% rate of abortion medication completion without additional intervention, and a .5% risk of serious adverse events, both comparable to rates after in-person exams.

Plans moving forward to put constitutional amendment before voters in 2024 to preserve access to abortion in the state. Two previous statewide elections, in 2006 and 2008, rejected legislative efforts to ban abortion in most cases.
As states grapple with the future of abortion in the U.S., Michigan, California, and Vermont could become the first states to let voters decide whether the right to abortion should be written into the state constitution.
The event was intended as an action in peaceful civil disobedience, and Omar’s office announced shortly ahead of the event that “these types of protests have led to arrests of lawmakers in the past.”
In addition to the recent ban on telehealth administration of the medication, legislators in the state may soon target providers outside the state mailing the medication into South Dakota. The ensuing legal fight is one of many uncertainties to be sorted out by the courts.
Abortion-related legislation planned for the special session will instead be introduced during the regular legislative session early next year, the governor said in a joint statement released Friday afternoon.
Abortion may be covered by a health plan, but if no providers are available, patients don’t have access. However, people with insurance that does not cover abortion can still get one — but only if it’s available in their states or they can afford to travel and pay out-of-pocket. There are also a host of unanswered questions about whether states that restrict abortion will have the legal authority to target abortion coverage in employer plans.

"No-test medication abortion," the authors concluded, "can lower costs, result in earlier treatment, increase convenience and privacy, and allow patients to avoid harassment at clinics" thereby increasing access to those who reside in rural locations and marginalized groups.


The data, reported within a study published in March of this year in the journal JAMA Internal Medicine, were supplied to the FDA prior to their permanently lifting a requirement that access to medication abortions first obtain an office visit.

According to Ushma Upadhyay, lead author and an associate professor of obstetrics at the University of California, San Francisco, those using medication abortion are likely to learn about an ectopic pregnancy even earlier than those receiving a standard 10-week ultrasound during pregnancy.

"Within a couple of days they will realize they are not having the expected cramping and bleeding that comes with a medication abortion," Upadhyay said in an interview with Forum News Service. "So they wouldn't have to wait a full month, (the awareness) would come within a few days."

Upadhyay said concerns about other risks were also not borne out by the data. "These medications through the mail are extremely safe and effective," Upadhyay said. "There is a much bigger legal risk than medical risk."

In a statement issued June 24, U.S. Attorney General Merrick Garland announced the Justice Department's legal position that states cannot cite safety or efficacy to prevent the use of an FDA-approved abortion medication.

“States may not ban Mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy," Garland stated, offering a federal position concerning the regulation of drugs, which is joined by the ability of states to regulate the practice of medicine within their borders.

The Justice Department further asserted that states could not prevent anyone from telling patients how to get the drugs.

"Moreover," Garland noted, "under fundamental First Amendment principles, individuals must remain free to inform and counsel each other about the reproductive care that is available in other states."

Related Topics: ABORTION
Paul John Scott is the health correspondent for NewsMD and the Forum News Service. He is a novelist and was an award winning magazine journalist for 15 years prior to joining the FNS in 2019.
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