The Case for Telemedicine Abortions

It was the middle of March 2020 when Miranda first realized she was pregnant. The world had just shut down due to COVID-19, and in response to the pandemic, Texas Governor Gregg Abbott deemed abortions nonessential medical procedures. Abortion clinics opened and closed eight times during the first month of lockdown and Miranda’s only resource became crisis pregnancy centers, which primarily exist to encourage women not to have abortions. At one point, Miranda even made plans to drive to New Mexico to receive proper abortion care. It didn’t matter that she was in the middle of a raging pandemic—it was her only option. Finally, by the end of April, Miranda’s luck turned and she was able to arrange an appointment at the Dallas abortion clinic several hours away from her home. But even then, since she wanted a medication abortion, she needed to schedule three appointments to complete the procedure.

Abortion deserts were an issue long before the COVID-19 pandemic, but the respiratory virus only worsened issues of accessibility. In 2017, 89% of counties in the United States did not have clinics that provided abortions. 38% of women of childbearing age lived in these counties and would need to travel in order to find access to proper care. Fast-forwarding to March 2020, abortion care became even more inaccessible. Miranda was lucky to schedule an appointment in Texas, but “there’s been over a 700% increase in patients leaving Texas to seek abortion in other states over the last few weeks,” acting president of Planned Parenthood Alexis McGill Johnson said in an interview with Vice News last year.

Meanwhile, Ashley hails from Hawaii, where telemedicine abortions have long been legal for the sake of patient convenience. Instead of flying 200 miles to Honolulu in the middle of the pandemic, Ashley joined a video conference with an OB/GYN from the comfort of her own home. She was able to stay at home with her 3-year-old daughter and talk to a medical professional about her abortion, all without having to worry about unnecessary expenses. Within the next few days, the two pills Ashley needed for her abortion were sitting in her mailbox.

Mifepristone, more commonly known as the abortion pill, was made available to American women in September 2000 after a twenty-year battle between pro-life and pro-choice advocates. In 2017 this treatment option accounted for 39% of abortions, and its popularity continues to rise.

The FDA typically requires the abortion pill to be administered in person, but states like Hawaii are able to work around this rule by participating in TelAbortion, an FDA-approved research study that allows women to see their providers virtually and receive their abortion medication by mail. When pandemic-related lockdowns were instituted, demand for virtual care skyrocketed. Thanks to the pill’s size and portability, it seemed like the perfect solution in the middle of a pandemic. Research conducted at the University of Texas at Austin demonstrated statistically significant increases in requests for self-managed abortion care in eleven states after March 2020. In Texas, one of the states with the heaviest restrictions on abortion care, there was a 94% increase in requests for self-managed abortion care.

By June 2020, a federal court ruling blocked the FDA’s in-person administration requirement. This allowed other states to follow Hawaii’s precedent for telemedicine abortions during the pandemic. Women nationwide were able to receive abortion care via telehealth, and abortion pills were sent to their home addresses.

The federal courts’ assistance in blocking FDA regulations provided a glimmer of hope because it made abortion care more accessible than ever before. Not as many women needed to drive hundreds of miles across state lines in order to receive proper care. More women in rural areas, who were already disproportionately affected by the novel coronavirus, were able to maintain access to abortion care should they need it.

This new pandemic practice, however, is in danger of being reversed. Right before leaving office, Trump made a request to the federal courts: reinstate in-person abortion requirements.

With vaccines more readily available, COVID-19 no longer places an excessive burden on women seeking abortion care. But the issue of access remains. The Supreme Court has a conservative majority, states have been passing anti-abortion bills in efforts to chip away at Roe v. Wade, and 27 states still qualify as abortion deserts.

This is why the telehealth ruling that was passed during the pandemic should be generalized, and state-sanctioned laws restricting virtual reproductive care should be repealed. Telemedicine abortions need to be a standard practice because in the movement to make quality reproductive healthcare available to all women, telemedicine is a solution with benefits that would endure far beyond the pandemic.

It is important to realize that blocking this rule is not a cure-all. Burdensome regulations continue to serve as a barrier to abortion care. 24 states can prohibit virtual care thanks to state-level legislature; 19 states have state-level in-person requirements, 11 states have ultrasound requirements, and 14 states demand in-person counseling.

Our federal and state-level legislations assume responsibility for public health. It is the FDA’s job to protect public health, but their risk evaluation and mitigation strategy (REMS) rule on the abortion pill forces in-person administration and thus poses more dangers than benefits to public health. The states that echo these requirements only perpetuate the ongoing accessibility issues in this country. The abortion pill, when taken with the guidance of a professional, has a 95% success rate, and serious complications have occurred in approximately 0.4% of cases. Mifepristone is a medication that, when taken properly, is relatively safe and easy to use. Its administration requirements do not align with such realities. Continuing to curb access, however, means that more women are less likely to get the medical care that they need.

This is not an argument about the morals of abortion care. The topic is a tricky one because of the way it intersects with faith and politics, but for my argument’s sake, let’s take a step back from the political. Let’s think about this as healthcare, nothing more and nothing less. Healthcare should be equally accessible for all American citizens, but this is not currently the case. And given technology’s recent rise, we can change this by taking advantage of virtual care.

By Anita Mukherjee

Indie rock enthusiast and home chef who will always make time to watch a stand-up special