Motivations for obtaining advance provision of medication abortion in the United States: a qualitative study

Background: Advance provision of medication abortion, or the prescription of mifepristone and misoprostol before pregnancy occurs, is an unexplored care model aimed at expanding abortion access. We examine motivations for obtaining advance provision from the online telemedicine service, Aid Access, which supports people in the United States.

Methods: Between May and November 2023, we conducted semi-structured, in-depth interviews with 39 people who obtained advance provision between January 2022 and April 2023. Interviews were transcribed and we conducted a thematic analysis to assess individual motivations.

Results: Participants were motivated to obtain medications because of the Dobbs v Jackson Women's Health Organization (Dobbs) draft opinion leak and eventual decision. Participants expressed concerns about access to abortion under current and future abortion restrictions. Concerns about restrictions prompted people to make a backup plan for themselves and loved ones, and participants compared advance provision to other emergency medications and practices. Some participants were motivated to have medications on hand because pregnancy would be either unsafe or difficult. Others were trying to become pregnant, but because of their health histories they were cognisant of the health risks of a desired pregnancy. Overall, participants were motivated to take back control of their reproductive autonomy in the face of inevitable abortion bans.

Conclusions: The need for autonomy, resistance and reassurance were woven throughout participant's motivations for obtaining advance provision. The Dobbs decision acted as a catalyst for action to take back reproductive autonomy and prepare for a lack of access to abortion care.