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Providing abortion pills before patients need them could enable earlier care

ANSIRH researchers Katherine Ehrenreich, M. Antonia Biggs, and Daniel Grossman authored an editorial in BMJ Sexual & Reproductive Health exploring the potential for clinicians to provide medication abortion pills to patients before they are pregnant, a model called “advance provision.” Doing so would enable patients to have the pills on hand when necessary, enabling earlier access to care.

The authors believe the model holds potential and merits further study—particularly considering the United States’ current political environment. The model would effectively shorten the time between the decision to have an abortion and obtaining care to zero days.

The authors note that state legislatures have implemented restrictions, including Texas’ recent SB 8, that have increased the distance to the nearest provider for many people, sometimes requiring hundreds of miles of travel. Hurdles posed by travel are often compounded by additional concerns, such as childcare, job obligations, and mandatory waiting periods. These, in turn, lengthen the delay between a patient’s initial need for an abortion and their treatment. But even in settings where there is good access to care in the United States, there is inevitably some time between the first call to the clinic and the in-person appointment to obtain medication abortion.

The authors outline a potential approach to the advance provision model, with clinicians screening patients for some contraindications to medication abortion prior to pregnancy in addition to providing any necessary education. The research team sees advance provision as a “complete care model,” which would also include access to necessary follow-up care in case of complications, ongoing pregnancy, or incomplete abortion.

At the same time, the researchers acknowledge possible challenges with the model, including self-administration at inappropriate times and medication diversion. It is unlikely, too, that advance provision could be adopted in all U.S. states.

Still, studies on its safety and how patients can use the medications with limited clinician oversight could provide contributory evidence toward an eventual move toward over-the-counter availability of mifepristone and misoprostol for medication abortion.

Ehrenreich, Biggs, and Grossman write:

"While a future landscape of medication abortion may include telemedicine and mail-order pharmacy dispensing, advance provision may be a preferable option for those who would continue to face barriers to care, including those travelling to areas with limited options for safe abortion."

The article, Making the case for advance provision of mifepristone and misoprostol for abortion in the United States, is available in BMJ Sexual & Reproductive Health. A PDF of the article is available upon request.