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Your Abortion is in the Mailbox: A Study of Abortion Seekers’ Understanding of their Choices in 2023
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Toma, Roxana, Tally, Margaret
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Fall 2023
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2023-12-17
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On June 24, 2022, the U.S. Supreme Court issued a ruling in Dobbs v Jackson Women’s Health Clinic, overturning its 1973 decision in Roe and allowing states to regulate abortion. Twelve states immediately criminalized abortion care, precipitating chaos around the country. In Texas, abortion clinics had closed in September 2021, causing patients to travel to Oklahoma and beyond. Oklahoma's clinics closed in May 2022. After Dobbs, residents of Oklahoma and Texas joined residents of three other states seeking limited clinic appointments in access states like Kansas, Illinois and Colorado. More than 50% of these appointments were for medication abortions. Due to changes in federal regulations about telehealth care, abortion pills could also be ordered online, letting prospective patients obtain the same pills available in clinics at home, without travel.
The goal of this study is to understand why abortion-seekers from Texas and Oklahoma chose to travel long distances for their pills, instead of ordering online. Clinic patients were surveyed to answer the research question: What do women who choose to travel to a clinic for medication abortion, from their homes in states where it is extra-legal or illegal, believe about telemedicine and clinic provision?
The study was approved by the Institutional Review Board of SUNY Empire State University. Data was collected April-June 2023 at a medication abortion clinic in Kansas. Adult residents of Texas or Oklahoma who traveled to the clinic for a medication abortion were offered a survey during their visit. The survey collected demographics and asked which alternatives the patient considered to end the pregnancy, which factors influenced their decision to travel to the clinic, and whether they thought that mailing abortion pills for home use is legal in their state. If they considered a method using mail-order pills (abortion pills online or telehealth), they were asked why they decided against it.
Findings indicate that speed to appointment date was the top priority for the patients sampled; at the time of data collection, mail-order pills could take up to three weeks to arrive. Legality of the clinic appointment was also a concern for a majority. Privacy was a secondary concern. Seeing a doctor, the defining feature of a clinic visit, did not seem important. While many respondents were concerned about the legality of ordering pills for home use, most were confused about whether it was legal in their state.
Based on these findings, policy implications of the shift to self-managed abortion and the impact of abortion access on public health outcomes are explored. Policy recommendations are offered to support access to abortion, despite criminalization of abortion practice in 13 states. Further study is needed to understand what information and messaging informs potential users of at-home abortion about their options.
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A thesis submitted to the Graduate School of Social and Public Policy at SUNY Empire State University to fulfill the requirements for the degree of Master of Arts