Telehealth is becoming a bigger part of our lives. Those visits are also being used for abortions, but the rules vary from state to state, and even federally.
“Back in March of last year in 2020, at the height of the pandemic, I found out I was pregnant in the state of Ohio,” Larada Lee explained.
Soon after, she made the decision to get an abortion.
“I also had to go to three different appointments and it was really, really tough because people couldn't come in with me,” she explained.
Telemedicine appointments weren’t an option in her state.
“I kind of had to risk my life to go get abortion pills when I was going to do the other half of the procedure at home anyway,” she said.
It’s a state by state decision, and in Ohio, along with other states, there are laws blocking medical professionals from prescribing abortion pills via telehealth.
“I got the first half of my abortion pill at the clinic and took the other half home,” Lee said.
Nineteen states require the clinician providing a medication abortion to be physically present when the pill is given, meaning no telehealth to prescribe remotely.
Last year, as the pandemic grew, a federal judge blocked the FDA’s federal requirement that a patient meet a physician in person before receiving abortion pills. Then in January, the Supreme Court restored those federal rules. However this April, the FDA announced a temporary stop on enforcement.
“The FDA issued this letter saying they were going to exercise enforcement discretion related to the in person dispensing requirement,” said Dr. Daniel Grossman, Director of Advancing New Standards in Reproductive Health, and professor at the University of California, San Francisco. “A letter from the FDA doesn't take precedence over any state laws.”
That's putting many states, like Ohio, in the middle of the debate.
“Telemedicine is extremely helpful in a lot of ways, but dangerous drugs like the abortion pill are not one of those things that should be dispensed remotely,” said Allie Frazier with pro-life organization Ohio Right to Life.
“We believe that no woman should be put at risk to have to undergo the harrowing process of chemical abortion by herself, possibly hours away from the physician who prescribed her those drugs,” she said.
“There are just a lot of things that having that in-person visit with the doctor could prevent a lot of problems and certainly help that woman,” said Carol Tobias, President of the National Right to Life Committee.
Pro-life representatives said this lack of in-person communication, coupled with the fact that women may live far from emergency medical care, is dangerous. However, Dr. Grossman disagrees.
“We have 20 years of data on safety in the United States and this is a very well studied product. It’s very, very safe,” he said.
And in areas where access is possible, the demand is growing.
“In Illinois, we have been able to use telemedicine in a variety of different ways over the last six to nine months,” said Dr. Colleen McNicholas, Chief Medical Officer at Planned Parenthood of the St. Louis region.
“We definitely saw numbers of medication abortion increase,” she said.
In Illinois, pills can even be sent directly to a woman’s home.
“Folks more and more are choosing medication over aspiration procedures,” Dr. McNicholas said.
Each state is looking at different regulations when it comes to telehealth abortion appointments. For clinicians like Dr. McNicholas, this is just another avenue a woman can take when making a decision.
“For some folks, a demedicalized abortion experience from their couch is exactly what they need and want. For other folks they want to be in the health center and be able to physically put their hands on a provider. Both of those are important options. So this is just another way to help open up access consistent with what the medicine and scientific evidence shows us is safe,” Dr. McNicholas said.
“Lifting the telemed ban on the abortion pill is doing a lot for accessibility, I mean we’re not just talking about the hurdles that existed before in terms of getting an abortion, we’re also talking about a pandemic,” Larada Lee said.