Terri first realized she was pregnant in late March. She was isolating at home with her boyfriend in rural upstate New York, where she runs a housecleaning business. At 46, she was sure she didn’t want to become a 60-year-old parent to a teenager. “I was like, ‘No, that’s not going to happen,’” says Terri, who asked to be identified by her first name only. She called the nearest Planned Parenthood clinic, a 40-minute drive away, and took the first appointment available, which was a week-and-a-half later. Uninsured, Terri says she planned to show up at the clinic and “throw [herself] at their mercy.”
But before her appointment, she read about telemedicine abortion. All that was required was a phone consultation with a doctor to establish whether she was less than 10 weeks pregnant (the limit for medication abortion’s approved use by the U.S. Food and Drug Administration). Once proven, the clinic would deliver abortion pills by mail, allowing for a quiet, non-surgical procedure at home. For Terri, this was a far better option than potentially exposing herself to COVID-19 at a clinic.
Terri is among the many women across the United States who are facing new barriers to abortion care as some conservative states use the pandemic to justify halting procedures, classifying abortions as “non-essential.” In this new environment, telemedicine abortion has gained new momentum, with health care advocates expanding its geographical reach and streamlining protocols, so as to minimize in-person clinic visits.
Telemedicine abortion was pioneered in the United States to address provider shortages by bringing doctors into clinics via videoconference to regions where abortion access is limited. Now, the practice has become a way of bringing providers directly into patients’ homes, bypassing clinics altogether.
So, how does it work? Previously, a telemedicine abortion typically required patients to obtain an ultrasound or pelvic exam at the nearest medical facility to confirm a pregnancy. But in response to the coronavirus crisis, more clinics are offering “no-test” procedures wherein a patient answers a series of questions by phone with a doctor in order to date their pregnancy. Once a gestational age has been established, patients then make just one clinic visit to pick up the pills, due to a federal regulation that mandates pills be dispensed in a doctor’s office or clinic.
Telemedicine abortion has become a way of bringing providers directly to patients’ homes, bypassing clinics altogether.
Even that is starting to change. In 2016, Gynuity Health Projects, a New York-based research and technical assistance organization, launched the TelAbortion study to evaluate sending abortion pills by mail. (As a research study filed with the Food and Drug Administration, it’s exempt from the in-clinic dispensation requirement.) To date, Gynuity’s clinic partners have mailed nearly 850 packets of pills in the 13 states where the study is active.The number of women who had abortions through the study doubled in March and April, compared to the first two months of this year.
As state governments place additional restrictions on abortion access, Gynuity says it’s gearing up for a spike in demand for services. “I think as things get more and more restricted, we will see our numbers increase,” says Erica Chong, a director at Gynuity and co-director of the study. To reach patients in states where telemedicine abortion is illegal, some of Gynuity’s clinic partners have run digital ads in areas bordering the study states and finding creative ways to get pills to patients. For example, after having a consultation in a participating state, some of Gynuity’s clinic partners “have sent packages with the medication to FedEx offices right near the borders,” Chong says. “They will hold the packages for [patients to] pickup.”
Carafem, a network of reproductive health clinics that offers telemedicine abortions in Georgia, Illinois, and Maryland, also is seeing increased interest in its services as restrictions take effect. Its clinic in Illinois, which is surrounded by states with some of the strictest abortion regulations in the country, experienced a 50 percent rise in demand for telemedicine procedures in the first two weeks of April. Melissa Grant, Carafem’s chief operations officer of Carafem, says she had to assign additional staff to field calls and online requests from residents of Ohio, Wisconsin, Indiana, and Missouri.
Uptick in demand of procedures
In New York, the epicenter of the coronavirus, there has been a sharp uptick in demand for procedures by mail. “Our calls from New York are picking up significantly,” says Leah Coplon, program director at Maine Family Planning, which employs doctors licensed in New York and operates as a clinic partner in the TelAbortion study. “We’re getting calls daily, which was not the case before.”
From her home in the Catskills, Terri was one of those callers. She dialed Maine Family Planning on a Tuesday. A staff member determined her eligibility for the TelAbortion study, after which she had an intake consultation, which included detailed instructions on how to take the pills and what to expect. She then “met” with the doctor, via her iPhone, who provided the prescription. The pills arrived the following Tuesday. When we spoke the next day, Terri’s heaviest abortion-related cramping had passed, and she was due for a virtual follow-up appointment with a nurse within a week. “Now with things being closed, I can’t imagine going in [to a clinic],” she says.
Overall, studies in the United States and overseas have found telemedicine abortions result in high patient satisfaction, few complications, and comparable results to standard abortion care. Despite its track record of safety, eighteen states currently ban telemedicine abortion. As the practice increases in popularity, abortion advocates say they worry additional states may ban telemedicine abortion specifically. It could also be vulnerable to the same laws that have already caused widespread clinic closures across the country.
Case in point: In February, Republican senators in Congress introduced the Teleabortion Prevention Act of 2020. “It’s as easy to stop legal telemedicine abortion as it is to create obstacles for a clinic,” says Frances Kissling, a bioethicist and the former president of Catholics for Choice, a pro-choice advocacy group. “We should use it as long as we can, but…if the climate on the abortion remains the same, it has a shelf life.”
What feels like a new normal now could eventually just become normal.
Others, however, are optimistic the COVID-19 pandemic will yield lasting changes to how abortion is provided in the United States. “If we learn through research that there are simplified ways to provide services that are still equally effective and acceptable to the patient, then that’s how the medical process changes,” says Grant of Carafem.
In other words, what feels like a new normal now could eventually just become normal. For Terri says protecting herself from the menace of the coronavirus is just one of the advantages of telemedicine abortion. She didn’t face antiabortion protesters who often stand outside of clinics, and in the comfort of her own home, she could perform personal rituals as she underwent the procedure.
She apologized to her body and acknowledged what she called “the mistake to even begin to draw forth a life.” Her boyfriend sat beside her. “It sounds stupid but you have your cats, your bed, your tablet, so you can support yourself,” Terri says. “Emotionally, too, you can say whatever you need to say.”