Telemedicine Abortion Services Not as Accessible to Many in Need
December 1, 2023 5 minutes read
Medication abortion through telehealth services has grown dramatically in the past couple of years, but it is not accessible to everyone who may need the service.
For example, younger people, those with health conditions, and those with limited English proficiency are less likely to use telemedicine abortion services.1
Investigators interviewed 30 patients, half of whom received their abortion through telemedicine and the other half through in-person clinic visits, says Emily Godfrey, MD, MPH, professor of family medicine and OB/GYN at the University of Washington School of Medicine.
“The theme that came up, especially for young people, was the lack of trust around telemedicine and wanting to physically go to a place to make sure it was real,” Godfrey explains. “In some ways, young people are even more savvy about what’s online and realize there’s a lot of fake information.”
Godfrey recalls a 19-year-old pregnant patient who first visited a clinic where staff tried to talk her out of seeking an abortion. The patient searched for an abortion clinic online and found that one.
“That explains why young people were more likely to go to a clinic in person,” Godfrey says. “There’s always the concern of whether these pills are real, and will they work?” Young people are concerned about the lack of regulation on the internet, she adds.
The access barrier for people with limited English proficiency involves the way telemedicine providers use interpretation and translation services. “If I need to call patients who are not English-speaking, they have it set up with a centralized system where I can get whatever language is needed, and the person doing the translation calls the patient in a three-way call,” Godfrey explains. “It’s not seamless, and I think smaller clinics [may not] have the resources.”
More people may use telemedicine abortion services if they know more about it. Outreach campaigns can help with that, such as billboards on interstate highways leading to Illinois from the Seattle-based Shout Your Abortion campaign, which seeks to normalize abortion services.2
Shout Your Abortion also offers a website with resources, including information about obtaining abortion pills via telemedicine for a self-managed abortion.3
“Any healthcare professional who knows how to assess pregnancy could prescribe medication abortion,” Godfrey says. “Before [the overturn of] Roe, 95% of all abortions were in big clinics. People trust Planned Parenthood.”
But when researchers interviewed pregnant people during the pandemic, the interviewees reported that Planned Parenthood was backed up by three to four weeks in appointments. “When people end up with an unplanned pregnancy, there’s a sense of urgency about that. To wait three weeks is unacceptable,” Godfrey says.
Although access to telemedicine abortion services was enabled during the pandemic and has expanded in the last year, the service is so new that barriers remain. “For example, the University of Washington started offering abortion care via telemedicine about three months ago [in summer 2023],” Godfrey says.
When more institutions provide these services, people likely will gain confidence and trust in them. “I don’t think anyone is going to question UW’s health system. It’s a trusted name — not just in Washington state, but throughout the whole region,” Godfrey says.
It has taken time for institutions to offer telemedicine abortion services because of federal barriers and restrictions regarding mifepristone prescribing. “The patient has to sign the agreement form in the moment. As a provider, I can’t send the prescription to pharmacies until I have the patient agreement form signed,” Godfrey explains. “It was very difficult to manage that electronically, and some patients are calling on their cellphone and may not have true internet access.”
Plus, health systems use their own patient privacy guardrails, so it can take a lot of time and expertise in the legal and information technology departments to implement telemedicine abortion care in a way that feels seamless on the patient’s side.
“We send the patient a link, counsel them, we take a medication history and make sure the patient is an appropriate candidate for this care, and then we have to send a link that the patient signs before the clinician can prescribe mifepristone,” Godfrey says. “It’s our pharmacy that dispenses it, and it won’t dispense mifepristone without the patient’s signature.”
Washington has enacted a shield law that allows physicians to prescribe mifepristone to patients anywhere in the country. “I’m only licensed to practice in Washington, but I am aware of other providers in Washington who are prescribing to people all over the country,” Godfrey says.
Since the overturn of Roe v. Wade, Washington has seen a 36% increase in abortions from 2020, according to the Guttmacher Institute’s data. Between 2017 and 2020, abortions increased by only 1%.4
Washington state stockpiled mifepristone after a federal judge in Texas ruled in April 2023 to suspend the Food and Drug Administration’s (FDA) approval of mifepristone. Within a couple of hours of that decision, a federal judge in Washington state ruled the FDA must keep medication abortion drugs available. The U.S. Supreme Court granted a full stay in the case, preserving access to mifepristone pending other court decisions.5
Other states that have become a refuge for people seeking abortions also have seen big jumps in their rates of abortions. For instance, abortions in Colorado have increased by 89%; Illinois by 69%; and New Mexico’s abortions have skyrocketed by 220%.4
With more people traveling to states without abortion bans, the clinics that provide the service are overwhelmed. Telemedicine abortion services can help ease the congestion and reduce wait times for those who need or desire in-person abortions.
“It’s burdensome to get pregnant in a place where abortion is illegal, and it’s time lost from work,” Godfrey says. “The more care is delayed in pregnancy, the more likelihood complications will arise.”
Family planning clinics also could prevent access barriers and improve wait times by offering patients telehealth appointments for contraception. “At the time of tele-abortion, you can provide oral contraceptive pills,” Godfrey notes. “You can prescribe the patch, vaginal ring, and emergency contraception.” This would make in-person appointments available for people who want an implant or an intrauterine device.
The goal is to expand access to abortion care in a nation that has swiftly moved through state legislation to ban or sharply restrict all abortion services.
“The marginalized populations will suffer the most,” Godfrey says. “The need to have control over one’s children and pregnancy is a basic human right.”
REFERENCES
- Fiastro AE, Zheng Z, Ruben MR, et al. Telehealth vs in-clinic medication abortion services. JAMA Netw Open 2023;6:e2331900.
- Blank C. Billboards supporting women seeking abortions are popping up along I-55 heading north. NPR. Oct. 11, 2023.
- Shout Your Abortion. Abortion pills/at home abortion. 2023.
- Maddow-Zimet I, Baden K, Jones RK, et al. New state abortion data indicate widespread travel for care. Guttmacher Institute. Sept. 7, 2023.
- Dwyer D, Hutzler A. Supreme Court keeps status quo on abortion pill for now, Thomas and Alito dissent. ABC News. April 21, 2023.
Medication abortion through telehealth services has grown dramatically in the past couple of years, but it is not accessible to everyone who may need the service. For example, younger people, those with health conditions, and those with limited English proficiency are less likely to use telemedicine abortion services.
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