Self-managed abortions rose by more than 26,000 in the six months after the U.S. Supreme Court overturned Roe v. Wade nearly two years ago, according to a?peer-reviewed study?published Monday in JAMA, the American Medical Association’s journal.

Researchers determined that an increase of approximately 27,838 online orders of abortion pills between July and December 2022 corresponded to the findings of an additional 26,055 medication abortions reported outside the formal health care system, the study found.

The Dobbs v. Jackson Women’s Health Organization ruling in June 2022 overturned the federal right to abortion, returning the decision to the states and leading to?14 with near-total abortion bans.

The study was published a day before the nation’s highest court is set to hear arguments in a case over the federal approval of?mifepristone, one of two drugs used for medication abortions. A decision in favor of an anti-abortion group could limit access to mifepristone, even in states with protective abortion laws.

Alliance for Hippocratic Medicine, an anti-abortion group of physicians, is asking the court to rule that the U.S. Food and Drug Administration should revert to pre-2016 mifepristone regulations. The change would reduce mifepristone’s use from 10 weeks gestation to seven, alter the dosage, require three in-person visits, and only allow doctors to provide medication abortions, among other restrictions.

Lawyers for the Biden administration are?urging?the court to keep the current regulations on the drug.?Hundreds of studies point to the pill’s safety. Since the FDA approved mifepristone in?2000, 32 deaths have been associated with the drug’s use as of December 2022.

Regardless of the outcome, the JAMA research suggests that some people in states with strict abortion bans have found ways to terminate their pregnancies outside of a clinician setting.

“Given the increases we’ve seen and reductions in access, we could make a good guess that a lot of these pills are going to states with those bans,” said?Abigail Aiken, a University of Texas at Austin public affairs professor and the study’s lead author.

Researchers analyzed data provided by telemedicine organizations — such as Aid Access, an international abortion pill provider, community networks and online vendors. Community networks — organizations run by volunteers that sometimes work offline or through hotlines and provide pills at no-cost to recipients? — accounted for more than half of all abortion pill orders. Online vendors are websites that give various price options for buying abortion medications.

Post-Dobbs, there was an estimated monthly average of 5,931 provisions — orders — of abortion pills from those main sources. That’s a 322% increase from a pre-Dobbs average of 1,407 provisions per month, according to the study.

Despite the availability of abortion pills, Aiken said some people may not want to terminate a pregnancy without clinician support. She noted from her previous 2016 research in?Ireland, before the country legalized abortion in 2018, feelings associated with self-managed abortion, including isolation.

“They oftentimes wanted to connect with the formal health care setting,” Aiken said.? “They were experiencing prolonged symptoms and wanted to make sure they didn’t need help.”

Aiken’s latest study broadens the scope of research on medication abortions since the end of Roe.

Abortions through telehealth?increased?post-Dobbs, according to a Society of Family Planning #WeCount?report?published last month. They made up 16% of all reported abortions as of September 2023. Before Dobbs, just 4% of all abortions were telehealth abortions.

“Telehealth abortion has really had a huge impact,” Ushma Upadhyay, a professor at the University of California, San Francisco’s Advancing New Standards in Reproductive Health, told States Newsroom in February. “We’re addressing unmet need that existed in those states, even before Dobbs. I think that a lot of the unmet need in the blue states is being met, as well as people traveling from states with abortion bans.”

A report released last week by the Guttmacher Institute showed that?63% of all clinician-provided abortions in the U.S. last year were medication abortions.

There were more than 1 million abortions provided in the formal health care system in 2023, the largest number since 2012. In 2020, medication abortions made up 53% of all abortions, according to the institute.

The data “helps paint the picture of the extreme need that we are experiencing around reproductive health in this country,” said Monica Simpson, the executive director of?SisterSong, a Georgia-based reproductive justice organization.

Simpson said a Supreme Court decision restricting medication abortion access would create a scenario similar to the aftermath of the Alabama Supreme Court?ruling?that said frozen embryos are “unborn children.” That ruling brought fertility services in the state to a standstill until the governor signed legislation providing?criminal and civil immunity?to IVF providers and patients.

“Our opposition — these anti-abortion extremists — this is what they want. They want to intentionally create chaos around us,” she said.