We envision a world where medication abortion would be available and accessible through a variety of means – community distribution models, in-person providers (including primary care providers), telehealth, and over the counter at pharmacies. And, people would have access to the full range of support that they need and want – whether it’s support from loved ones, medical providers, trained peer counselors, doulas, accompaniment networks, or other resources.
Ibis is leading work to lay the groundwork for an over-the-counter future of medication abortion access in the United States, including co-coordinating the medication abortion over the counter (MAB OTC) coalition, and conducting research in partnership with reproductive justice and advocacy organizations to understand people’s perspectives on medication abortion over the counter and holistic support needs.
Medication abortion over the counter
Medication abortion pills (mifepristone and misoprostol) meet many of the Food and Drug Administration’s (FDA) criteria for over-the-counter access – they are safe, pose no overdose risk, nonaddictive, and are safely and effectively used around the world without health provider involvement. Access to medication abortion over the counter, where people can pick up medications at a local pharmacy, without a prescription, would improve access to medication abortion for many by reducing the need to travel for abortion care, reducing financial and logistical barriers to clinic-based care, and increase reproductive autonomy.
Working towards a future where medication abortion is available over the counter to all is underpinned by several strategies and support of existing priorities: eliminating abortion restrictions, protecting access to mifepristone and removing the REMs, expanding cadres of abortion providers, expanding access to abortion throughout pregnancy, and ensuring people have all the resources they need to have a supported and high-quality medication abortion experience.
The MAB OTC Coalition
Ibis Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), and the Generative Learning Community on SMA coordinate the medication abortion over the counter (MAB OTC) coalition. The MAB OTC coalition is a growing group of abortion providers, lawyers, advocates, researchers and others who are interested in learning more and participating in activities related to MAB OTC. We hold several meetings and webinars throughout the year about research, legal and regulatory pathways, and advocacy related to the long-term vision of MAB OTC, as well as send updates on our work via email. If you are interested in joining the coalition, please reach out to Samantha Ruggiero.
Abortion Ecosystem of Support Study
Ibis, in partnership with SisterSong, the Afiya Center, Advocates for Youth, the National Network of Abortion Funds, and the National Asian Pacific American Women's Forum, is conducting research with people from communities across the country most impacted by abortion restrictions and who face heightened barriers to care. Our research seeks to better understand 1) the holistic needs of abortion seekers before, during, and after their abortion and 2) their perspectives, questions, and concerns about a future MAB OTC product. We also conducted key informant interviews with experts from across the reproductive health, rights, and justice movements.
To date, we have conducted 21 key informant interviews, and 14 focus group discussions with 89 participants.
Participants describe how abortion seekers face layered, intersecting barriers: cost of abortion services, lost wages, childcare, transportation, criminalization fears, immigration enforcement, intimate-partner violence, and stigma. Parents, Black and Latinx communities, LGBTQ+ people, immigrants, youth, rural residents, people with disabilities, and those living in poverty faced amplified barriers. Participants describe a strained but resilient abortion ecosystem delivering clinical care, informational, logistical, legal, and financial support across the access continuum.
Many participants expressed enthusiasm about a MAB OTC product and thought it could make abortion more accessible, offer a convenient, affordable, and private option, help destigmatize abortion, and build public knowledge on MAB safety. Participants emphasized the importance of ensuring accessible, local in-person abortion care if people prefer or need follow up, as well as the need for MAB OTC to be affordable and covered by insurance/Medicaid. Some participants had concerns around patchwork legality, pharmacy harassment, age/identity verification, coercion, and clinic financing. Participants identified several resources that would make a MAB OTC model successful: emotional, physical, and spiritual support; clear guidance for before, during, and after the abortion; and a 24/7 hotline or textline for live support.
Briefs summarizing findings from our research can be found below.