Improving Access to Medication Abortion via Telehealth
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. Medication abortion can be safely and effectively administered via telehealth, which can help extend care to remote and otherwise underserved communities. Lifting current 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.
Understanding Telehealth and Its Potential
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. Telehealth has long been hailed as a promising way to expand health care, including highly specialized care, to rural and otherwise underserved communities. As of December 2018, 79 million Americans in rural and urban areas lived in federally designated primary care Health Professional Shortage Areas.
Innovative telemedicine programs are helping connect patients with specialists in coordination with their local health care providers. This use of telehealth can help address provider shortages: Half of U.S. counties lacked an obstetrician-gynecologist in 2017, and more than 10 million women lived in those predominantly rural counties. 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.
The Medication Abortion Process
Abortion pills were approved by the FDA 20 years ago and involves using two medications to end a pregnancy – mifepristone and misoprostol. Mifepristone blocks progesterone, a hormone required for pregnancy to continue, and misoprostol induces uterine cramping, which results in a period-like process to remove the pregnancy. Telehealth for abortion pills is both safe and effective; it is the same care you would receive in-person at a health center, but within the comfort of your own home.
Service Requirements and Protocol
To access this care via telehealth, patients must follow specific clinical protocols:
- Take a home pregnancy test to confirm pregnancy status.
- Ensure date of your last menstrual period (LMP).
- Note: A patient’s LMP needs to be no more than 11 weeks ago at the time of taking mifepristone.
- Ensure you can be physically in the required jurisdiction during your appointment and have an address to which the medication can be sent.
You will be screened for initial eligibility and then scheduled for a telehealth appointment. At the time of your appointment, you will receive a call from a nurse, who will review your questionnaire and provide a deeper overview of the process. Finally, you will meet with a nurse practitioner who will walk you through the instructions for taking the medication. Following the visit, the team will package and send out your two medications through a discreet package which should arrive within 3-5 business days. Throughout the process, you will have 24/7 access to an on-call nurse.
Data Summary of Telehealth and Access Barriers
The following table summarizes the key statistics and components regarding telehealth and reproductive health access based on provided research:
| Category | Details and Statistics |
|---|---|
| Provider Shortage (2017) | Half of U.S. counties lacked an obstetrician-gynecologist. |
| Health Professional Shortage Areas | 79 million Americans lived in designated shortage areas (Dec 2018). |
| Medication Components | Mifepristone (blocks progesterone) and Misoprostol (induces cramping). |
| Clinical Eligibility | LMP no more than 11 weeks ago at the time of taking the first medication. |
| Delivery Timeline | Discreet shipping typically arrives within 3-5 business days. |
Policy and Accessibility
Numerous policy barriers, some specific to abortion and others not, currently limit the reach of telehealth abortion. 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 solution to these gaps is telehealth, which is increasingly being used to make medication abortion available in new areas.