As use of telehealth for medication abortion grows, new data offer window into patient population
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Population-based rates of telemedicine abortion were highest in Southern and Midwestern states, particularly those with abortion bans, during a 15-month period starting in July 2023. That's when several telehealth abortion providers, including Aid Access, began prescribing medication abortion under state shield laws intended to protect abortion care providers who treat patients in areas with bans. In those 15 months, 84% of Aid Access' prescriptions went to patients in states with near-total abortion bans or bans specifically on telemedicine abortion. Notably, rates of abortion provision were higher in areas where people had to travel farther to the nearest clinic, and in counties with higher poverty levels.
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The study 'confirms that telehealth really changed the abortion care landscape,' said Upadhyay, echoing results from a
Telehealth's growth is not just a product of state shield laws, said professor of law Nicole Huberfeld, who co-directs Boston University's program on reproductive justice. 'It's also a reflection of the necessity that exists across the country in places that were already maternity care deserts and or medically underserved areas.'
When patients visit a telehealth website that provides medication abortion, they undergo the same screening process they would in person, said Elisa Wells, co-founder of Plan C, an informational site about self-managed medication abortion. A survey or provider will screen for medical contraindications like bleeding disorders or factors that might put a patient at risk of an ectopic pregnancy. If medication is prescribed, a patient will receive information about when and how to follow up with questions or concerns, and how to spot signs of an incomplete abortion.
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In-person abortion care, including both procedural and medication abortion, remains much more common than telehealth. But 'there's growing support in the community for this model because restrictions have become tighter, and the likelihood of people accessing procedural or clinic-based abortion is becoming nonexistent in many states,' said Subasri Narasimhan, a public health social scientist at the Emory School of Medicine.
Even in states where in-person abortion care is legal and readily available, telehealth abortion can be preferred because of the convenience it offers. 'There's the travel, there is the time off work, the stigma of having to go to an abortion clinic and sit in a waiting room,' said Upadhyay. Telehealth can also be more affordable: Aid Access and similar sites often offer a sliding payment scale, with many visits and prescriptions costing $200 or less.
Concern over restricted access to abortion care has driven several distinct surges in telehealth demand. Honeybee Health, a mail-order pharmacy that fulfills medication abortion prescriptions,
Medication abortion's safety, and telehealth's by extension, has been called into question repeatedly by lawmakers and anti-abortion organizations during the second Trump administration. When asked during his Senate confirmation hearing whether he would end telehealth access to mifepristone, FDA Commissioner Marty Makary said he would 'build an expert coalition' to review the medication's postmarket safety data. On prodding from abortion opponent Sen. Josh Hawley, (R-Mo.), Makary has recently
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At the same time, shield laws are being put to the test, as the authors of a JAMA
'Our laws are not yet a match for telehealth and its promises and perils,' said Huberfeld, who co-authored the editorial. 'I think that we will continue to see that there is this mismatch so long as we are relying on state laws for regulating access to care.'
By the end of 2024, a monthly average of more than 12,000 medication abortions were provided to patients in states with bans or telehealth restrictions, according to data from the Society of Family Planning. As patients attempt to access abortion care, findings from Aid Access 'underscore the public health importance of telemedicine, both as an alternative to the unsafe abortion methods that prevailed under abortion bans before Roe v Wade and as a means of reducing access disparities,' wrote the study's authors.
'These are life-saving services for so many people, especially the poorest of the poor,' said Upadhyay. 'These providers are really filling a public health gap where people need these services.'
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