Telehealth widens access to abortion care as lawmakers restrict it
Two years ago this week, the Supreme Court ruled that abortion is not constitutionally protected in the U.S., a decision that would draw protests across the country. Since then, 14 states have outlawed abortions.
Still, some people in those states have been able to cut through barriers to get abortions via telehealth, according to a recent report from the research project #WeCount. Usually, this requires a virtual visit with a telehealth care provider. The provider assesses the patient and gets their information, then can mail them mifepristone and misoprostol, which aid in ending a pregnancy. The Supreme Court preserved access to mifepristone in a ruling this month, which means it can still be prescribed and mailed to patients.
Marketplace’s Lily Jamali discussed telehealth abortions with Ushma Upadhyay, professor of OB-GYN and reproductive sciences at the University of California, San Francisco, and a coauthor of the #WeCount report. The following is an edited transcript of their conversation.
Ushma Upadhyay: Right before the Dobbs decision [undoing Roe v. Wade], telehealth abortions made up about 4% of all abortions. And as of our last month of data that is available in December 2023, it made up 19% of all abortions. So it’s about 1 in 5 abortions in the United States today are done through telehealth.
Lily Jamali: Can you tell us what the data looks like in states where abortion is banned or where access has been pretty severely limited?
Upadhyay: Sure. In the 14 states where abortion was banned, we noted that there were 145,000 fewer abortions. We also have been looking at the number of abortions provided through shield laws. And these are laws that reduce the risk for providers to offer telehealth abortions to people living in states with abortion bans or bans on telehealth abortion. We found that 48,000 people living in states with abortion bans or restrictions were able to access abortion care through telehealth, through these providers offering care under shield laws.
Jamali: Your report seems to reflect just how big of a role telehealth now plays in giving people access to medication abortions after Dobbs, even in places where abortion is now banned.
Upadhyay: That’s right. And we’re also seeing really large increases in states where access has never been a problem. We’re seeing increases in Massachusetts, in New York, in California, in Illinois. And some of this is people who are traveling into these states. But we also know that because of telehealth, and because of the expanded policies, we’re seeing that a lot of the unmet need for abortion in these states is now being addressed through this expanded access.
Jamali: Do you have a sense of why, what is it about being able to access these medications using technology, using telehealth, that’s made such a difference?
Upadhyay: Yes, telehealth has really changed the experience for abortion patients. We have done a lot of research on telehealth abortion. We followed over 6,000 patients, we just published a paper and we found that safety and effectiveness was equivalent as in-person medication abortion care. So when a person goes to a Planned Parenthood, for example, and picks up their medications, it is the same in terms of safety and effectiveness. What’s different is that it removes so many of the barriers that people face with in-person care, and actually the cost is significantly lower through telehealth abortion because it’s a more streamlined process. Additionally, the stigma, people don’t worry so much about having to face protesters or having to talk to a lot of people before they get their medication abortion. And so that is another way it has really opened access for patients.
Jamali: So when you look at where we are as a country, where so many barriers are being thrown up to limit abortion access, how important would you say technology has been at helping people find ways around those barriers?
Upadhyay: I think the entire field has had to become more innovative and rely more on technology to expand access to abortion. Technology has been critical in this moment. And because medication abortion care is so safe, it can be offered in the mail, people can take it on their own with minimal supervision. I think that is one of the reasons why people who do not support access to abortion want to curtail its access. But technology has really made a huge difference in enabling people to get access to these medications.
Jamali: Do you have any thoughts on where that innovation might lead us from here? Telehealth is obviously a huge innovation. It’s been a few years now, but it’s obviously really grown in the last couple of years, especially since the pandemic. But where do you see that innovation going from here?
Upadhyay: I think what’s incredible about telehealth abortion is that there’s two types. There’s synchronous and asynchronous. Synchronous is when there’s a video call between the provider and the patient. That’s a real-time interaction. But there’s also asynchronous, which has become very popular, where a patient comes and completes a medical screening form and they answer any questions that the provider has over text at their convenience. A patient can be at work and be messaging with their provider. And if they are approved, then they receive the medications by mail. So the entire process is done asynchronously, they don’t even have to have a real-time conversation with the provider. And that has really opened access. I think it’s made what previously was really stigmatizing and difficult for people to be able to have access to these medications is really life changing for so many people. And we’ve also found that patients who have this asynchronous model, they said that they felt more cared for because there were multiple text interactions with their provider throughout the entire process. And so technology has really amazing potential to go further beyond this point, especially in states with abortion bans. I see increased support for people who have questions about their care using technology, using text messaging throughout their entire process.
Jamali: I’m really struck hearing you say that because I think there’s an impression that using tech for such an intimate and personal process and a procedure that can be really painful in so many different ways, that there might be this impression that technology can be very impersonal. So to hear you say that people felt very cared for is very interesting to me.
Upadhyay: Right. We were surprised. I think in a context where people are accessing these medications in states that ban abortion, it provides some level of security where they can text people a little bit more anonymously, especially when they don’t want to involve their loved ones, their family because they want to protect them from legal risk. Sometimes people feel very alone going through this when they’re living in a state with an abortion ban. So technology has kind of given people a lifeline to be able to access clinical support, just counseling, just help when they need it, especially in the context of abortion bans.
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