What Role Will Telemedicine Abortions Play if Roe v. Wade Is Struck Down?

With the future of abortion rights at risk, telemedicine abortion service providers may be critical to reproductive care.

woman at home using her phone for telehealth appointment
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Fact checked on May 27, 2022 by Vivianna Shields, a journalist and fact-checker with experience in health and wellness publishing.

With abortion rights hanging in the balance as the Supreme Court prepares to hand down a decision on the landmark Roe v. Wade case, attention has turned to telehealth abortions and what role they may play as reproductive rights in this country become more limited.

A small crop of telehealth abortion services have established themselves across the United States in recent years. These providers typically offer online consults and dispatch FDA-approved medication abortion pills by mail.

Some experts say these types of services may represent the future of abortion access if Roe v. Wade is ultimately struck down. But as the country becomes a patchwork of individual state laws and restrictions surrounding abortion and reproductive rights—including far more restricted usage of abortion pills—what exactly will that future look like? And how widely accessible will telehealth abortions really be?

It's an important question as the nation stares down a seismic shift in the reproductive rights landscape.

What Are Telehealth Abortions and Who Offers Them?

Telehealth or telemedicine abortion typically involves either a phone call or video visit with a remote provider who's certified to offer such services and then a medication abortion using two medications to end a pregnancy: mifepristone and misoprostol. The medication can be taken in the comfort of a patient's home.

As part of the initial remote visit with a provider, patients interested in this procedure may fill out a form detailing their personal medical information and history, information used to determine whether a medication abortion is a feasible option.

"Then the healthcare provider either in real-time or after reviewing the form decides whether you are eligible for medication abortion care," Kirsten Moore, director of Expanding Medication Abortion Access (EMAA Project), told Health. "[If you are], the healthcare provider sends the prescription for mifepristone and misoprostol to a mail order pharmacy and the mail order pharmacy delivers the medication to patients."

A 2021 report from the Kaiser Family Foundation pointed out that few people are aware of telemedicine services of this type. The same report said research shows that providing medication abortion prescriptions via telemedicine consultation is clinically feasible and safe.

A variety of telehealth providers have sprung up in recent years specifically to offer telehealth abortion services including:

Still other providers offer telehealth abortions, in addition to various other types of reproductive or medical care. These include organizations like carafem, Choix, Metro Area Advanced Practice Healthcare, Maine Family Planning, Planned Parenthood, and Whole Woman's Health.

Pandemic-Driven Rise of Telehealth Abortions

Even before current events threw the future of Roe v. Wade into question, telehealth abortions began to increase in popularity. Such services became a useful alternative amid a global pandemic that left medical providers across the nation overwhelmed and made social distancing a necessity.

"We've known that [telehealth abortion] is a doable thing for a long time, just slow to take on. The pandemic created more pressure on abortion providers to adapt and get creative," said Moore.

In addition to the pandemic driving more widespread use and acceptance of telehealth services in general, there were also legal changes in 2021 that allowed telehealth abortion services to suddenly become more feasible.

Up until December 2021, Moore explained, certified telehealth abortion prescribers had to meet certain requirements including being doctors, as well as being certified to prescribe abortion medication, and having to pre-purchase and stock abortion medication in their clinics in order to dispense them directly to patients. Because of this reality, Moore said many healthcare professionals avoided becoming certified telehealth abortion providers.

"It's not just any health care professional who can prescribe mifepristone, the FDA still has restrictions in place that requires licensed health care professionals to certify to be able to offer this medication," said Moore.

More recently however, the FDA has loosened at least one of those requirements, which may change how widely telemedicine abortion services are available.

"Now the FDA is allowing the mail order pharmacies to deliver [the abortion medication], and that is opening the door to brick-and-mortar pharmacies," said Moore. This change may also encourage more healthcare professionals to opt into the certification process.

Is Telehealth Truly the Future of Abortion Access?

Telehealth providers that prescribe medication abortions in the United States are licensed in specific states, which allows them to offer care to patients in those states. The Center for Reproductive Rights explains that abortion providers licensed in a particular state are required to provide such care in compliance with that state's law.

"If a state bans the mailing of abortion pills, providers are required to comply," states the Center for Reproductive Rights. "Violating state law can subject a provider to the loss of their license and, potentially, criminal or civil penalties."

Additionally, residents of such states may not be able to get pills sent to them from other states—all of which can limit just how accessible telehealth abortions will really be for some individuals.

Abortion On Demand (AOD), for instance, provides care within the legal framework of the states where it operates. "We do not mail medications to restrictive states and make great efforts to ensure our legal compliance in all the states we serve," Leah Coplon, CNM, MPH, director of clinical operations at AOD, told Health.

And as safe as medication abortions have been shown to be, there are still a few safety questions to be considered when discussing how widespread this option may ultimately become. There are instances when either because of a patient's medical history or gestation, medication abortion may not be the best choice, Coplon said.

"Medication abortion is certainly not a panacea to solving the problems overturning Roe will unleash, but it's one piece of the puzzle of providing access to as many people as possible," Coplon said.

Implications for Telehealth if Roe v. Wade is Overturned

For AOD at least, overturning Roe v. Wade is not likely to change operations much. That's because most of the states in which it operates will continue to allow care via telehealth, said Coplon. And most of the states that are likely to ban abortion if Roe is overturned, already ban telehealth medication abortion, she added.

What may change however, if Roe v. Wade is overturned, is the volume of patients seeking care.

"We may see some patients who travel to a safe state and choose to stay there to do a telehealth medication abortion—an option that is primarily for those with the means to do so, and not for the majority of abortion patients who are disproportionately lower income and have children already making travel challenging," said Coplon.

There also may be longer wait times in safe states for in-clinic care with more people traveling to those states, which may lead an increased number of patients to choose a telehealth medication abortion in order to get care more quickly.

"Ideally, people should be able to choose the kinds of abortions they want, but that may no longer be a reality," Coplon said.

A future in which individuals travel to states where telehealth abortion is legal is something Moore foresees as well. In such cases, patients would undergo a virtual visit and have the medication sent to them in the safe state.

It's also important to point out that if your state bans abortion care and you self-source medication abortion, Moore said you or anybody who helps you access medication may be at legal risk.

"We now have to ask ourselves which side are we going to be on when it comes to civil disobedience because there are people who need abortions and there are people who love people who need abortions," said Moore.

Some states will try to criminalize providers and patients for sending or taking pills in states where abortion is banned, Coplon added.

"One of the many particular cruelties of these vigilante bills that we're seeing in Texas and Oklahoma and will likely see more of, is that people will be afraid to talk to trusted friends, families, nurses, and doctors if they have medical concerns not just about abortions, but about miscarriages, stillborns, and more," said Coplon. "This is what puts people at risk. Not medication abortions. And, the people most affected by these bans will be the people who are already most affected by systemic racism and bias in the healthcare and criminal justice system."

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