Mexico-Based Accompaniment Collectives for Abortion in the US After Dobbs.

Importance: With increasing abortion restrictions, more people self-manage their abortions with medications. Little is known about geographic and demographic characteristics of those self-managing abortions in the US, particularly after the Dobbs v Jackson Women's Health Organization decision. Objective: To describe requests for self-managed medication abortion support in the US through Mexico-based accompaniment collectives. Design, Setting, and Participants: This is a cross-sectional study of records from 2023 from 2 Mexico-based accompaniment collectives. Participants were people in the US requesting support from Mexico-based accompaniment collectives to self-manage an abortion. Exposures: State abortion policy context (complete abortion bans, 6-week and/or embryonic cardiac activity bans, 12- to 15-week bans, and abortion available past 15 weeks), sociodemographic characteristics (poverty, insurance status, and Spanish language), and driving distance from the nearest abortion facility. Main Outcomes and Measures: The primary outcomes were the sociodemographic characteristics of those requesting support from accompaniment collectives and the rate of requests to these collectives by zip code tabulation areas (ZCTAs). Demographic characteristics, pregnancy characteristics, and state policy context were described. Differences in request characteristics by state-level abortion policy category were tested using χ2 tests. Also, rates of requests per 100 000 female individuals aged 15 to 49 years within categories of ZCTA-level characteristics were estimated. Results: A total of 2850 requests were analyzed, with 700 requests (24.6%) from people aged 20 to 24 years, 995 (34.9%) from people aged 25 to 34 years, and 192 (6.7%) from people younger than 20 years. Pregnancy duration was 6 weeks or less for 1441 requests (50.6%), 7 to 9 weeks for 677 requests (23.8%), and 12 weeks or more for 160 requests (5.6%). In total, 2363 requests (82.9%) were from states with complete abortion bans. Requests with pregnancies at 12 weeks or more ranged from 98 (4.2%) in complete-ban states to 36 requests (14.8%) in states where abortion was available past 15 weeks (P < .001). Spanish was spoken with accompaniers by 65 requesters (38.0%) in states where abortion was available past 15 weeks and by 282 requesters (13.2%) in complete-ban states (P < .001). The mean ZCTA-level request rate was 2.44 (95% CI, 1.81-3.08) per 100 000 female individuals aged 15 to 49 years and increased with ZCTA-level poverty (from 0.35 [95% CI, 0.23-0.53] to 1.63 [95% CI, 1.14-2.34] requests per 100 000 female individuals aged 15 to 49 years) and Spanish-speaking population share (from 0.25 [95% CI, 0.12-0.54] to 1.56 [95% CI, 1.03-2.39] requests per 100 000 female individuals aged 15 to 49 years). ZCTAs more than 8 hours from an abortion facility in complete ban states had the highest request rate (7.85 [95% CI, 4.53-13.61] requests per 100 000 female individuals aged 15 to 49 years). Conclusions and Relevance: In this cross-sectional study of accompaniment network records, requests for Mexico-based accompaniment support were highest in states with abortion bans and in communities with elevated poverty, uninsurance, and Spanish-speaking populations, underscoring the role of accompaniment collectives in serving communities facing the greatest structural barriers to facility-based abortion care.