Imagine you take a cruise in late February. When you get back to the U.S., you start to self-quarantine out of concern that you were exposed to coronavirus on the ship. Then you find out you are pregnant. You do not want to be. What do you do?
If you were in Canada, you could get a doctor to prescribe you what is colloquially known as the “abortion pill,” which you could pick up from your local pharmacy. Using medication abortion, women end their pregnancies by taking a combination of two drugs, usually spaced 24 hours apart, which essentially cause a miscarriage.
Medication abortion is safe, effective and allows people to terminate their pregnancies from the privacy of their own home, provided they are in the early stage of pregnancy. But in the U.S., federal regulations require that women physically travel to abortion clinics ― which could be hundreds of miles away ― to pick up the medication. You can’t get it from a pharmacy or through the mail.
A growing chorus of reproductive health experts are calling for that to change. They say that telemedicine ― the practice of using technology to provide care to a patient from a distance ― is safe for medication abortion and should be employed now, as the coronavirus pandemic overwhelms the health care system, doctors cannot travel to faraway clinics and patients may be trapped indoors.
“People across the country are being urged to stay at home and limit social interactions as much as possible,” said Megan Donovan, senior policy manager at the Guttmacher Institute. “Visiting a health center in person is an unnecessary risk for patients and providers if someone is eligible for medication abortion and it can be provided to them at home.”
The Trump administration and a handful of governors have already taken steps to expand access to telemedicine in the wake of the coronavirus outbreak. The public is taking advantage of remote health care services like never before. But abortion care by telemedicine is still strictly limited.
That’s because the Food and Drug Administration (FDA) requires that mifepristone, the first of the two drugs used to end a pregnancy, may only be dispensed in “clinics, medical offices, and hospitals by or under the supervision of a certified healthcare provider.”
In practice, that means that women seeking an abortion must generally go into a clinic to obtain the pills. In an emailed statement, the FDA’s Office of Media Affairs said that “certain restrictions, known as a risk evaluation and mitigation strategy (REMS), are necessary for mifepristone when used for medical termination of early pregnancy in order to ensure that the benefits of the drug outweigh its risks.”
As coronavirus spreads across the U.S., doctors who provide abortions are now trying to work out how to best assist patients in their homes, without violating state and federal regulations.
“We’re gearing up to be able to provide care to as many people as we can, balancing what’s going on with COVID-19 with ensuring our patients have access to sexual and reproductive health care,” said Meera Shah, chief medical officer of Planned Parenthood Hudson Peconic.
Her clinics in New York state have already been contacted by patients with symptoms of coronavirus, she said. Her staff is currently developing a new protocol for medication abortion so that most of the counseling and paperwork is done remotely, using telemedicine. But patients will still need to physically come in to get the pills, she said, due to FDA regulations.
Leading health experts say this is unnecessary.
The overwhelming medical consensus is that medication abortion is safe and the current restrictions are not justified by the limited risks posed by the drugs. A study published in 2019 found that people who received medication abortion by mail had similar outcomes as those who received it at a physician’s office and reported high levels of satisfaction with the service. The American College of Obstetricians and Gynecologists recommends that mifepristone be made available in retail pharmacies, like other prescription drugs.
Telemedicine for medication abortion is particularly important in the 27 “abortion deserts” in the U.S. — major cities where women have to travel more than 100 miles to access an abortion. Six states in the U.S. have only one clinic remaining.
“As a necessary part of healthcare, abortion should not be sidelined.”
Beyond the FDA rules, onerous state regulations can make it even harder for people to access medication abortions. As Ghazaleh Moayedi, an abortion provider in Texas, told HuffPost earlier this week, women in her state must make three separate visits to a clinic, in person, if they want to obtain a medication abortion.
“This is a time period where we should be focusing on moving all health care to telemedicine, minimizing the number of patient contacts within a clinic,” she said. “We could be moving all our patients in the first trimester to telemedicine for medication abortion so they don’t have to come in at all.”
In some states, a limited form of telemedicine for medication abortion already exists. While patients are still required to travel to a health clinic for care, once there, they can consult via telemedicine with a clinician in another location who is authorized to dispense the drugs. This method minimizes how far patients must travel to find a doctor who provides abortions, and allows physicians to extend their reach into underserved communities without physically traveling to remote locations.
In 12 states, pregnant women can get the abortion pill by mail by participating in a study called the TelAbortion Project. Under the protocol, women obtain the necessary tests at medical facilities near their home. They do a video evaluation over the internet with an abortion provider. Then the drugs are sent to them by mail. (You can find out if you qualify here.)
“Our patients are very satisfied,” said Erica Chong, the co-director of the study. “They feel like it fits into the constraints of their life very well, it accommodates them and meets them where they are.”
She said her team was trying to rapidly expand services to additional states where there are no bans on telemedicine abortion. Currently, 18 states prohibit the use of telemedicine to prescribe medication for abortion remotely. A bill in Ohio to ban telemedicine for medication abortion passed the state Senate earlier this month.
“I think there’s probably about 12 more states that we could probably expand to
reasonably quickly,” Chong said. “This is a really unprecedented time.”
Abortion access is already under threat. Now it’s being jeopardized by coronavirus. Telemedicine is a way to solve that. But first, public officials must understand that it’s a vital aspect of medical care that deserves to be taken seriously.
“There’s a reason that attention and resources are being deployed promoting and supporting telehealth as we grapple with COVID-19,” said Donovan, the Guttmacher policy analyst. “As a necessary part of healthcare, abortion should not be sidelined.”
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