Telemedicine and Abortion: A Natural Friendship?

Telemedicine has been used to improve access to care in many realms of medicine for years, particularly in rural settings. Since early medical abortion is a safe, highly effective, outpatient process that involves only pills, it is ideally suited to telemedicine. However, as telemedicine has expanded generally, legislators have specifically restricted telemedicine abortion care. The most common restrictions require these medications to be administered directly by a physician, or to be provided physically in a clinic (despite there being no evidence to support that this is safer or beneficial).

Since the beginning of the COVID-19 pandemic, telemedicine has taken on a greater role in our healthcare system. This surge of telemedicine care has provided new potential for telemedicine abortion care, but not without a fight. Read more here:

For the basics of telemedicine and how it can work in abortion care:

• Improving Access to Abortion via Telehealth

  Guttmacher | May 16, 2019

  Guttmacher outlines what telemedicine is, how it can be used to expand access to abortion care, and the current challenges and barriers to implementing telemedicine in abortion care. Of note, this was written before COVID-19, so it does not include information about how telemedicine’s use in abortion care in the past year.

Evidence to support what we know: people appreciate access and options: 

• Demand for Self-Managed Medication Abortion Through an Online Telemedicine Service in the United States

  American Journal of Public Health | Aiken et. al. | December 4, 2019

  This peer-reviewed paper assesses the demand for telemedicine abortion by looking at requests received by the organization Women on Web (WoW) from 2017-2018. They found that there was prevalent demand for online, self-managed abortion care.

And then COVID-19 hits…

• The Coronavirus Is Making the Case for Abortion Via Telemedicine

  Mother Jones | Becca Andrews | March 18, 2020

• More Patients Seek Abortion Pills Online During Pandemic, But Face Restrictions

  NPR | Sarah McCammon | March 8, 2020

  This NPR articles demonstrates the need for telemedicine in abortion care through the story of a woman in South Dakota who had to travel 3 hours, with her children, to access medical care during a pandemic because telemedicine abortion care was unavailable due to state restrictions.

• Abortion by Telemedicine: A Growing Option as Access to Clinics Wanes

  NY Times | Pam Belluck | April 28, 2020

  As COVID-19 spread through the US, so did the need for telemedicine abortion care. This NY Times piece showcases the stories of various patients who found telemedicine medication abortion to be their best option. This article focuses on the organization, TelAbortion.

A call from the professional Obstetrics and Gynecology community for telemedicine abortion access: 

• Telemedicine for Medication Abortion: The Time Is Now

  Current Obstetrics and Gynecology Reports | Betstadt et. al. | April 6, 2020

  This review article outlines current restrictions for telemedicine abortion in the US, strategies for incorporating telemedicine abortion into current models of abortion care, and evidence on the safety and efficacy of telemedicine abortion.

For more scholarly articles on telemedicine abortion and COVID-19:

• Demand for Self-Managed Online Telemedicine Abortion in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic

  Obstetrics and Gynecology | Aiken et. al. | July 20, 2020

• Introduction of telemedicine for medication abortion: Changes in service delivery patterns in two U.S. states

  Contraception | Julia Kohn, Hannah Simmons | December 23, 2020

For a list of projects, papers, and policy briefs related to improving telemedicine abortion care:

• Telemedicine projects to improve access to abortion care

  Ibis Reproductive Health

  Put together by Ibis, an organization with the mission of driving, “change through bold, rigorous research and principled partnerships that advance sexual and reproductive autonomy, choices, and health worldwide.”

To learn about some ongoing studies assessing the impact of telemedicine on abortion:

• Telemedicine for Medication Abortion

  ANSIRH

And then a final hit to abortion access under the Trump Administration:

• Supreme Court reinstates restrictions on abortion pill

  Politico | Alice Miranda Ollstein | January 12, 2021

  Just before the end of the Trump presidency, the Supreme Court heard its first case on abortion since Justice Amy Coney Barrett joined the court in Fall 2020. The outcome was a blow to telemedicine abortion care. In a 6-3 decision along ideological lines, the court upheld a request by the Trump Administration to reinstate a federal rule that requires patients to pick up their abortion medications in-person from a medical provider. This ruling severely restricted the scope of telemedicine abortion since it does not allow mifepristone and misoprostol to be shipped directly to patients. We hope that in the early days of the Biden presidency, the effect of this decision will be reversed both to improve abortion access and reduce the risk of COVID-19 exposure while accessing medical care.