It’s time to make the abortion pill available through telehealth
Ta few years ago this month, the Food and Drug Administration approved a drug destined to become known as the abortion pill. Mifepristone, then called RU486, would change everything about abortion – it would expand access and remove stigma.
I remember devouring the news because this little pill would give women reproductive autonomy and allow them to control whether and when they have children. At the time, I was just starting my doctorate. in public health. The news inspired and elated me, and I knew the abortion pill was what I wanted to focus my career on.
Medical abortion is a safe and effective alternative to procedural abortion. This involves taking two prescribed medications, mifepristone followed by misoprostol, to terminate a pregnancy that is no longer than 11 weeks along.
Fast forward to today. Many of the barriers to abortion that existed in September 2000 still exist today. Almost 90% of American countries do not have an abortion provider, and my research has shown that 27 big cities are “abortion deserts” where residents must travel 100 miles or more to reach an abortion provider.
The introduction of the abortion pill didn’t have the effect I hoped for, in part because the FDA put in place a strict set of rules known as risk assessment and mitigation strategy (REMS) on mifepristone. Among these restrictions is the requirement that mifepristone be dispensed in a clinic, doctor’s office or hospital, effectively prohibiting clinicians from prescribing it during a telehealth visit. In addition to these FDA restrictions, 19 states specifically prohibit the provision of the abortion pill via telehealth for purely political reasons.
As a public health scientist and abortion safety expert, I know these restrictions are outdated and medically unnecessary. Over the past 20 years, nearly 4 million pregnant women in the United States have used these two drugs to terminate their pregnancies. In a study that my colleagues and I conducted among more than 11,000 people who have had medical abortions, the rate of safety was more than 99%.
No matter where patients get the pills, they will almost certainly take them at home. In other words, receiving a prescribed pill in person by a doctor at a clinic rather than getting it from a pharmacy or in the mail makes it more or less likely that a patient will need emergency care. .
Medical abortion is easily administered via telehealth. In the context of Covid-19, social distancing and increasingly scarce medical services make it essential that state and federal governments set aside policy to allow patients to access abortion care through telehealth, instead of trying to further restrict abortion care.
The abortion restrictions that were in place before Covid-19 mean that some states have only one abortion provider and if that provider – or clinic staff – needs to self-quarantine, patients have even fewer options. For many patients, delaying an abortion may mean not having one at all. In the midst of a pandemic, these restrictions put lives at risk as patients still have to travel long distances to get to a clinic.
In July, a federal judge ruled that the in-person requirements for medical abortion are a significant obstacle during the pandemic and are unconstitutional. In states where the practice is not specifically prohibited, a clinician can now prescribe the abortion pill via telehealth and drugs can be delivered by mail, but only temporarily.
This is a step in the right direction, but it is time to definitively lift the medically unwarranted risk assessment and mitigation strategy. Clinic-to-clinic telehealth programs exist in some states, but even so, they require patients to go to a clinic for tests and to get the pills. The only home telehealth program for abortion is a study currently underway in 11 states with FDA approval.
But even with this program, in which patients have a telehealth consultation and can then receive abortion pills in the mail, this model still requires them to get an ultrasound from a clinic to confirm the pregnancy is within gestational time. which can be difficult. under current conditions and is not required for abortion care. Evidence has shown that calculating gestation based on the known date of a patient’s last menstrual period is very accurate for dating pregnancies.
Telehealth for abortion extends access to underserved areas, including rural areas where there are no providers. Telehealth can contribute to patient-centered care by providing an additional choice that meets patients’ needs for convenience and privacy. While telehealth allows for an abortion earlier, it can make abortion safer by moving all medical abortions earlier in the pregnancy.
Ensuring that people can have abortions as soon as possible may not seem urgent in light of the Covid-19 pandemic. But delayed abortion care can prevent people from wanting abortions, radically changing their life trajectories.
It is more urgent than ever that policymakers at the federal and state levels stop blocking access to mifepristone telehealth and start prioritizing science and public safety over politics.
Ushma D. Upadhyay is Associate Professor in the Advancing New Standards in Reproductive Health Program in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California at San Francisco, and Director of Research at the Global Health Institute at the University of California. Center of Expertise on Health, Gender and Women’s Empowerment.