Speaking Out with Carrie Baker: Telemedicine abortion is here to stay

  • Carrie Baker, the president of the Abortion Rights Fund of Western Ma. with signs supporting the Roe Act at her home in Northampton this fall. Gazette file photo

Published: 12/23/2020 9:30:49 PM

The COVID-19 pandemic is transforming many aspects of our lives, and abortion is no exception. Telemedicine is expanding access to abortion health care in ways that are likely to persist long after the pandemic is over.

Telemedicine abortion combines medication abortion — which uses pills to end a pregnancy — and telemedicine — which allows health providers to supervise the use of abortion pills via videoconferencing or telephone consultations.

Approved by the Food and Drug Administration for use during the first 10 weeks of gestation, medication abortion uses two types of pills: mifepristone, which interrupts the flow of the hormone progesterone that sustains the pregnancy; and misoprostol, which causes contractions to expel the contents of the uterus.

This combination of pills is 95% effective and is an extremely safe way to end an early pregnancy. According to the Guttmacher Institute, medication abortion now accounts for over 60% of abortions in the first 10 weeks.

Despite the safety of medication abortion, politically-motivated restrictions on mifepristone have blocked easy access to the pill. After years of anti-abortion resistance, the FDA approved the drug in 2000, but placed it in the Risk Evaluation and Mitigation Strategy (REMS) drug safety program. Under this restriction, the FDA prohibited retail pharmacies from stocking and distributing mifepristone, instead requiring doctors to register with the drug manufacturer and distribute the medication themselves in person to patients, who then take most of the pills at home. Whereas the REMS program is meant to restrict dangerous drugs, mifepristone is in fact an extremely safe drug — six times safer than Viagra, which is not similarly restricted. This FDA restriction was based on politics, not medical evidence.

Earlier this year, the American College of Obstetricians and Gynecologists (ACOG) and SisterSong Women of Color Reproductive Justice Collective brought a lawsuit challenging the FDA requirement of an in-person appointment for patients to receive the abortion pill during the pandemic. In July, a Maryland federal court temporarily suspended the requirement. The Trump administration challenged the decision but it was upheld earlier this month. Reproductive rights advocates are now pressing President-elect Joe Biden to ask the FDA to review and permanently remove the REMS restriction on mifepristone.

The other barrier to telemedicine abortion is the standard medical protocol that recommends an ultrasound to determine the number of weeks a patient is pregnant and an Rh blood test, which require an in-person visit. On March 30 of this year, however, ACOG issued guidance stating that an ultrasound and Rh testing are often not necessary because patients can reliably tell their doctors when their last period began and their blood type. The new “no-test” medication abortion protocol eliminates the need for in-person visits and tests in most cases.

As a result of the lawsuit lifting the FDA restriction on medication abortion and the new no-test medical protocol, telemedicine abortion startups are springing up across the country.

These new virtual clinics screen patients remotely, then mail abortion pills to them, often using new online pharmacies. In total, 19 states and Washington D.C. now offer legal access to telemedicine abortion from doctors within their state. I am not aware of any doctors doing this in Massachusetts, but hopefully some will soon.

These startups are revolutionizing abortion care by offering convenient services, especially for people living in rural areas far away from reproductive health clinics. They are also making abortion health care more affordable. Whereas in-clinic care with testing can cost $500-$700, telemedicine abortion costs as little as $95.

Another advantage of medication abortion is that patients can take the pills immediately after missing a period: they don’t have to wait until a fetus is visible on an ultrasound (approximately 6 weeks). In fact, some health care providers are prescribing medication abortion as “missed period” pills, without requiring a pregnancy test, which some patients prefer.

The organization Plan C has a comprehensive website at plancpills.org with information on medication abortion. The website includes all the new avenues for pill access that now exist in the U.S., including telemedicine services, online pharmacies, and reliable websites selling the abortion pill from abroad. Searchable by state, the website offers patients information about all of their options wherever they live, as well as information about financial support, legality and legal resources. Plan C also offers a toolkit for medical professionals with a step-by-step guide on how to become a medication abortion provider. My hope is that Massachusetts doctors will step up soon and begin providing this service.

Many people choose telemedicine abortion because it is more private and convenient than in-clinic medication abortion or procedural abortion by aspiration. Instead of having to drive to a provider and wait hours for an office visit, missing work or paying for child care, you can have your appointment from wherever you are without waiting, and take the pills when it’s convenient, like over the weekend or on your day off. Especially in states with few abortion clinics, or where protesters yell and scream at women entering reproductive health clinics, telemedicine abortion can increase access and reduce the stress of accessing abortion health care.

I suspect that these COVID-inspired innovations in abortion health care will persist beyond the pandemic. The cat is out of the bag. The obstacle course of expensive, burdensome and delayed abortion care should be a thing of the past. Accessible, affordable, early abortion care is possible. We just need the political will to make it happen.

Carrie Baker is a professor in the Program for the Study of Women and Gender at Smith College and a regular contributor to Ms. Magazine.

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