About 40% of all abortions in the US are now performed through drugs — rather than surgery — and this option has become even more important during the COVID-19 pandemic.
Abortion rights advocates say the pandemic has demonstrated the value of virtually delivered medical care, including the privacy and convenience of abortions that take place in a woman’s home rather than in a clinic.
Anti-abortion advocates, fearing the method will become more widespread, are pushing legislation in several Republican-led states to restrict and, in some cases, ban providers from prescribing abortion drugs via telemedicine.
Ohio enacted a ban this year and proposed felony charges for doctors who violate it. The law was due to go into effect next week, but a judge temporarily blocked it in response to a Planned Parenthood lawsuit.
In Montana, Republican Gov. Greg Gianforte is set to sign a ban on telemedicine abortions. The measure’s sponsor, Rep. Sharon Greef, has called medical abortions “the wild west of the abortion industry” and says the drugs should be taken under the close supervision of healthcare professionals, “not as part of a do-it-yourself abortion at a clinic or a Hospital”.
Opponents of the bans say telemedicine abortions are safe and a ban would disproportionately impact rural residents who have to make long journeys to the nearest abortion clinic.
“When we look at what state legislatures are doing, it’s clear that there is no medical basis for these restrictions,” said Elisabeth Smith, chief counsel for state policy and advocacy at the Center for Reproductive Rights. “They are only intended to make this incredibly safe drug more difficult to access and cast doubt on the patient-provider relationship.”
Other laws have tried to ban the delivery of abortion pills through the mail, shorten the 10-week window in which the method is allowed, and require doctors to tell women undergoing drug-induced abortions that the process can be reversed in the middle — a claim critics say isn’t backed by the science.
It’s part of a broader wave of anti-abortion measures that numerous states are considering this year, including some that would ban almost all abortions. Supporters of the bills hope the US Supreme Court, now with a Conservative majority of 6-3, may be ready to overturn the Roe v. Wade’s 1973 law that established statewide abortion rights.
Drug abortion legislation was inspired in part by developments during the pandemic, when the Food and Drug Administration — by order of a federal court — relaxed restrictions on abortion pills so they could be mailed. A requirement for women to pick them up in person is back, but anti-abortion advocates fear the Biden administration will end those restrictions permanently. Abortion rights groups are pushing for the move.
With the lifting of the rules in December, Planned Parenthood began shipping pills for telemedicine abortions in the St. Louis area, which are overseen by its health center in Fairview Heights, Illinois.
A single mother from Cairo, Illinois, more than a two-hour drive from the clinic, chose this option. Just months after giving birth to her second child, she found out she was pregnant.
“It would not have been a good situation to give birth to another child,” said the 32-year-old, who spoke on condition that her name not be used to protect her family’s privacy.
“The fact that I could do it from the comfort of my home felt good,” she added.
She was relieved to avoid a long journey and grateful for the clinician who guided her through the procedure.
“I didn’t feel alone,” she said. “I felt safe.”
Medicated abortions have been available in the United States since 2000, when the FDA approved the use of mifepristone. Taken together with misoprostol, it forms the so-called abortion pill.
The popularity of the method has grown steadily. The Guttmacher Institute, a research organization that advocates for abortion rights, estimates that abortions account for about 40% of all abortions in the US and 60% of abortions up to 10 weeks gestation.
“What makes medical abortion so significant, in addition to its exceptionally safe and effective track record, is how convenient and private it can be,” said Megan Donovan, Guttmacher’s senior policy manager. “That’s exactly why it’s still subject to annoying restrictions.”
Planned Parenthood of Southwest Ohio, which includes Cincinnati, says medical abortions account for a quarter of the abortions it offers. Of the 1,558 medical abortions last year, only 9% were performed via telemedicine, but the organization’s president, Kersha Deibel, said the option is important for many economically disadvantaged and rural women.
Ohio Right to Life President Mike Gonidakis countered, “No woman deserves to undergo the gruesome process of a chemical abortion, possibly hours away from the doctor who prescribed the drugs. ”
In Montana, where Planned Parenthood operates five of the state’s seven abortion clinics, 75% of abortions are performed through medication – a huge change from 10 years ago.
Martha Stahl, president of Planned Parenthood of Montana, says the pandemic – which has increased reliance on telemedicine – has contributed to the rise in the proportion of medical abortions.
In the vast state, which is home to rural communities and seven Native American reservations, many women live more than a five-hour drive from the nearest abortion clinic. Access to telemedicine can be important for them.
Greef, who supported the ban on telemedicine abortions, said the measure would ensure providers can watch for signs of domestic violence or sex trafficking when caring for patients in person.
However, proponents of the telemedicine method say patients are grateful for the convenience and privacy.
“Some are in bad relationships or victims of domestic violence,” said Christina Theriault, a Maine family planning nurse who can perform abortions under state law. “With telemedicine, they can do it without their partner knowing. There is a lot of relief from them.”
The group has health centers in far north Maine where women can receive abortion pills and take them at home under the supervision of health care providers who communicate by phone or video conference. It saves the women a three to four hour drive to the nearest abortion clinic in Bangor, Theriault said.
Maine Family Planning is among a small group of providers participating in an FDA-approved research program that allows women to receive the abortion pill in the mail after video consultations. As part of the program, the Maine group can also send pills to women in New York and Massachusetts.
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