Improving Access to Medication Abortion via Telehealth
Highlights:
- Medication abortion can be safely and effectively administered via telehealth, which can help extend care to remote and otherwise underserved communities.
- 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.
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. It could also allow for the growth of additional telehealth models that offer increased convenience, flexibility and privacy.
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.
Addressing Healthcare Shortages
Telehealth has long been hailed as a promising way to expand health care, including highly specialized care, to rural and otherwise underserved communities. This use of telehealth can help address provider shortages. The following table illustrates the current landscape of healthcare access in the United States:
| Metric | Statistic / Finding |
|---|---|
| Americans in primary care Health Professional Shortage Areas | 79 million (as of 2018) |
| U.S. counties lacking an obstetrician-gynecologist | Half (50%) in 2017 |
| Women living in counties without an OB-GYN | More than 10 million |
| U.S. hospitals using some form of telemedicine | More than half |
| Physicians using telemedicine for patient interactions | 15% (in 2016) |
Implementation of Telehealth Abortion Services
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.
Regarding the history of this model: 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, and some independent abortion providers have also begun integrating telehealth. Innovative telemedicine programs in states like Arkansas and South Carolina are helping connect pregnant patients with obstetrical and neonatal specialists, in coordination with their local health care providers.
Policy Barriers and Future Outlook
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. Lifting restrictions could expand abortion access to new and underserved communities and allow for the growth of additional telehealth models that offer increased convenience, flexibility and privacy.