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Health , US

The South’s abortion battle has a new front: telemedicine

by Erica Hensley February 18, 2022

Co-published with Reckon

Pregnant people in Georgia could soon have to make three separate trips to a clinic to access a common form of abortion that, under current law, they can see a doctor virtually to obtain.

A new bill making its way through the Georgia statehouse would criminalize access to abortion pills by telemedicine — a common, safe, easy way to end early pregnancies that the federal government first allowed last year.

“Telemedicine is an incredible option for people,” said Dr. Nisha Verma, OB/GYN fellow at Physicians for Reproductive Health, who provides abortions in Georgia. “We talk about abortion deserts among states, but even within the state too there are definitely these abortion deserts.” More than half of Georgians live in counties without an abortion clinic, and the new three-trip requirement would make seeking medical abortion — by pill — significantly more onerous than the traditional in-clinic procedure.

“There are people in Georgia that are having to travel hours to get to care. It feels ridiculous sometimes because literally all you’re doing is handing them a pill. That doesn’t need to be done in-person,” Verma said. “All of that creates a huge burden to care.”

Since it became an option last year, telemedicine has made abortion more accessible for patients who live in rural areas or can’t get off work, find childcare or transportation for care, she said. One in five women of reproductive age have to travel more than 80 miles to reach an abortion clinic. Other factors, like poverty, can cause people to wait longer to seek an abortion — especially in some parts of the Deep South where it’s more restricted — or forgo it all together when the barriers compound.

Related coverage: Abortion access is in jeopardy across the Deep South

If passed, the Georgia law will ban telemedicine abortion access by requiring in-person pill prescription and three separate visits to a clinic. Georgia already requires a 24-hour waiting period for abortions, and the bill mandates an additional in-person follow-up visit.

Despite the new federal rule, most Southerners don’t have expanded access to abortion pills. Currently, Georgia is one of only three Southern states — along with Florida and Virginia — that allow telemedicine abortion. As the fate of abortion access awaits the Supreme Court’s decision on Mississippi’s 15-week ban, most Southern states have preemptively restricted access to abortion pills by mail.

Overall, 19 states have restrictions on accessing medication abortion — prescribed in two pills, mifepristone and misoprostol — through telemedicine, despite its efficacy and safety.

Though the number of abortions overall has decreased in recent years, medication abortions have almost doubled to account for nearly half of all abortions, according to the U.S. Centers for Disease Control and Prevention. As access restrictions have spread across the South, these states in particular have seen surges in medication abortions.

In Georgia, pills went from accounting for 1 in 5 abortions in 2014 to half in 2019. In Mississippi, 70% of all abortions happen by pills — up from a third in 2014. Both Georgia and Mississippi have 6-week abortion bans on the books, which are blocked at the federal court level while the Supreme Court debates the fate of Roe v. Wade.

Even before the FDA loosened telemedicine abortion rules, people self-managed medication abortion through online ordering systems and mail delivery — COVID-19 and increasing abortion restrictions further popularized the process.

Related coverage: Could the coronavirus make telemedicine abortion the new normal?

“Telehealth is a real lifeline for access to medication abortion should states ban abortion,” said Elizabeth Nash, who researches state abortion policy at Guttmacher Institute. “Right now we are in a place where many states have banned telehealth for medication abortion, but where it is potentially available, it’s very important to maintain that … access to abortion care. And when access is curtailed, having access to telehealth is a real benefit.” Other Southern states that already ban telemedicine abortion, such as South Carolina and Alabama, currently have legislative bills that would take their restrictions a step further to further restrict or completely ban medication abortion. Both states also have concurrent bills that would ban all abortions.

Advocates reiterate, though, that abortion is still legal across the U.S. Despite statehouses’ efforts to limit access, most state bans — except for the 6-week law in Texas — are currently blocked at the federal level.

Like most abortion restrictions, experts say the Georgia bill is not based in science or standards of care, but aims to further limit abortion access in the state and region.

“It’s just really frustrating,” said Verma, the provider in Georgia. “The law’s telling me that I need to do things that are not based in science or data or evidence, and are not best for my patient.”

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