Marie, a 24-year-old in the Bay Area, had her abortion while lying on her couch and scrolling on her iPhone. In between work shifts as a barista and college classes, Marie had googled “abortion” and ended up on the page of an online clinic that provides telehealth medication abortions—in this case Choix Health. Like many telehealth patients, she looked through social media and online reviews, and decided she could trust them. Rather than schedule an appointment at one of the overwhelmed abortion clinics across the country, and have to request time off work, take a long drive, and pass through a barricade of angry protesters, Marie texted with a nurse from the privacy of her home. After the nurse took her information to determine if Marie was a good candidate for a medication abortion, the clinic mailed the pills to her house. She describes her experience as easy, private, and quick, and she would recommend it to others.
In many ways, Marie’s abortion represents an idyllic scenario, in which a patient is able to access care without the stress typically associated with in-clinic abortions, particularly since the Supreme Court overturned Roe v. Wade, sending the issue back to the states. Marie’s experience was without abortion stigma, travel, and protesters shouting in her face.
Similarly, Lacey, a 30-year-old in Colorado, had her abortion at home. Despite living in a state where lawmakers have fortified abortion access, Lacey preferred telehealth. When asked what led her to choose telehealth over a clinic, she mentioned her fear of protesters—which she experienced at an abortion clinic in Louisiana years prior. “Just imagine…people are screaming and yelling at you and showing you these photoshopped pictures of babies being vacuumed out of women’s wombs,” she said in an interview as part of our larger study on telehealth abortion. “That could be terrifying.” (We are using pseudonyms for both Marie and Lacey to protect their identities.)
Recently, a legal showdown has threatened to end the provision of abortion care via telehealth for patients like Marie and Lacey and turn back years of progress in health care through targeted legal attacks against mifepristone. Mifepristone is the first pill taken in a medication abortion, in addition to misoprostol. The FDA originally approved the two-dose regimen in 2000, and has since updated the protocol to allow patients to take it through 10 weeks of pregnancy, or 70 days since the first day of their last period. Despite the fact that the FDA gave its approval of the medication 23 years ago, and the fact that numerous studies have proven its safety and effectiveness, abortion opponents have targeted mifepristone. This is largely because mifepristone has been growing in popularity, makes having an abortion much easier, and enables people to have complete privacy and control of their reproduction.
In a surprise decision on April 21, the Supreme Court paused restrictions that were poised to severely limit access to the medication. Without this pause, a Fifth Circuit ruling would have reverted abortion care across the country to how it was provided before the FDA updated its requirements in 2016 in response to new clinical data. Prior to this update, clinicians had to rely on a less-effective protocol. While mifepristone has a safety rating of over 99 percent, these earlier FDA regulations required a patient to travel to a clinic, so that a physician (no nurses or other providers) could watch them take the first dose, and it could only be provided up to seven weeks into pregnancy. These archaic requirements go against what the latest science says will benefit patients most in accessing the care they need.
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Although telehealth abortion is currently available in only 25 states and Washington, D.C., because Republican-controlled legislatures have banned the provision of care in their respective states, it’s a pillar in reproductive health care. Telehealth abortion now accounts for 11 percent of all abortions in the United States, while in-clinic medication abortions represent more than half of all abortions in this country. Research shows that telehealth is as safe and effective as obtaining these medications in a facility.
As researchers on the California Home Abortion by Telehealth study, a prospective report on telehealth abortion in 20 states, we know that the safety and efficacy of abortions like Marie’s and Lacey’s are firmly established. We have followed the experiences of over 6,000 telehealth abortion patients at three virtual clinics around the country, as well as conducting in-depth interviews to gain a deeper understanding of peoples’ experiences. Many patients prefer the privacy of abortions in their own homes or communities, as well as the lower costs associated with telehealth abortion. Telehealth costs $285 on average, compared to the median cost of $585 for in-clinic medication abortion. Many in our study reported that they would have had to wait two weeks or longer for an appointment at a clinic, but they received their medicine within five days of their first contacting telehealth. Not to mention—as we do in one of our forthcoming research articles—that around half of patients surveyed said that telehealth made accessing a timely abortion possible—particularly patients disproportionately harmed by abortion bans, including patients of color, those living on low incomes and those in rural areas.
It’s important to note, however, that telehealth abortion isn’t for everyone. While medication abortions account for 53 percent of all abortions involving a clinic or via telehealth in the United States, some patients prefer to see a provider in a clinic. Others prefer a procedural abortion, for a variety of reasons. Some patients see a procedural abortion as a faster process, feel that it minimizes any legal risks if traveling from a banned state, or fear the pain and bleeding typical with a medication abortion. Some patients may need an in-clinic procedure because their pregnancy has passed the eligibility window for medication abortion. Additionally, telehealth clinics tend not to accept insurance, and most platforms offer their services only in English.
Efforts to increase reproductive autonomy in a post-Roe America must address these barriers to ensure access to all types of abortions across all pregnancy durations. At the same time, stories of telehealth abortion provide a glimmer of hope—a glimpse of a world in which patients are in control of where their abortion happens and when, with full privacy and respect for their decision and dignity.
And for this very reason, anti-abortion advocates remain laser-focused on taking away medication abortion and telehealth abortion care. The Supreme Court’s ruling last month sends the case back to the US Court of Appeals for the Fifth Circuit, which is scheduled to hear the case on May 17. We already know that the conservative appellate court wants to turn back the clock on access, and the case is very likely to return to the Supreme Court. The courts should understand that the freedom to control our bodies, lives, and futures is vital to all of us. Everyone should be able to make pregnancy and abortion decisions with privacy and autonomy and without barriers or political interference.
