Improving Access to Abortion via Telehealth

Medication abortion can be safely and effectively administered via telehealth, which can help extend care to remote and otherwise underserved communities. Telehealth is changing how people around the world access health-related information and services. In the United States, where access to abortion is highly politicized and varies from state to state, telehealth provision of abortion has improved access to care in some states. Yet federal and state restrictions limit whether and how patients can use this type of care. Lifting these restrictions could expand abortion access to new and underserved communities.

What Is Telehealth?

While there is no single, all-encompassing definition, "telehealth" generally refers to the use of electronic information and telecommunication technologies to facilitate the delivery of health-related information, education and services. It is often associated with the provision of clinical health care across long distances or outside of traditional facilities, and it includes both provider-to-patient and provider-to-provider interactions. Examples include everything from exchanging information or services via text messages, email, specialized software applications or video conferencing to performing complicated surgeries using robotic instruments guided by a clinician at a remote location. "Telehealth" sometimes refers to a broader range of interactions and exchanges than "telemedicine," but the terms are often used interchangeably.

The Need for Expanded Access and Rural Health

Telehealth has long been hailed as a promising way to expand health care, including highly specialized care, to rural and otherwise underserved communities. In 2005, the Institute of Medicine’s Committee on the Future of Rural Health Care noted that "appropriate use of [information and communications technology] can bridge distances by providing more immediate access to clinical knowledge, specialized expertise, and services not readily available in sparsely populated areas." The following data highlights the significant provider shortages currently impacting the United States:

• As of December 2018, 79 million Americans in rural and urban areas lived in federally designated primary care Health Professional Shortage Areas.
• In 2016, just 15% of physicians worked in practices that used telemedicine for patient interactions and 11% worked in practices that used it for interactions with other health care professionals.
• Half of U.S. counties lacked an obstetrician-gynecologist in 2017, and more than 10 million women lived in those predominantly rural counties.
• According to the American Hospital Association, more than half of U.S. hospitals use some form of telemedicine.

Telehealth Abortion Services and Policy Barriers

Abortion care in the United States has evolved as a primarily clinic-based service, segregated from the resources and infrastructure dedicated to other health care. As a result, there are huge gaps in access, including many areas of the country that are not served within a reasonable distance by a health center providing abortion care. One innovative, if partial, solution to these gaps is telehealth, which is increasingly being used to make medication abortion available in new areas. Examples from the maternal health arena demonstrate the potential of telehealth to expand access to a wide range of sexual and reproductive health care, including abortion care.

In 2008, Planned Parenthood of the Heartland pioneered telehealth access to abortion when it began using telehealth at health centers in Iowa not regularly staffed by a clinician providing abortion care. Today, Planned Parenthood health centers offer medication abortion via telehealth in at least 10 states. However, numerous policy barriers, some specific to abortion and others not, currently limit the reach of telehealth abortion. As new telehealth-related policies emerge and investments and infrastructure continue to grow, it is essential that abortion care is not overlooked—or purposefully excluded.