About 40% of all abortions in the US are now done through medication – rather than surgery – and that option has become all the more important during the COVID-19 pandemic.
Abortion rights advocates say the pandemic has demonstrated the value of medical care provided virtually, including the privacy and convenience of abortions taking place in a woman’s home, rather than a clinic. Abortion opponents, worried that the method is on the rise, are pushing legislation in several Republican-led states to restrict it and in some cases prohibit providers from prescribing abortion medications through telemedicine.
Ohio has issued a ban this year and has proposed crimes for doctors who violate it. The law was due to go into effect next week, but a judge has temporarily blocked it in response to a lawsuit over Planned Parenthood.
In Montana, Republican Governor Greg Gianforte is expected to sign a ban on telemedicine abortions. The sponsor of the measure, Rep. Sharon Greef, has called drug abortions’ the Wild West of the abortion industry ‘and says the drugs should be taken under the close supervision of medical professionals,’ not as part of a do-it-yourself abortion, far from a clinic or Hopital. “
Opponents of the ban say that telemedicine abortions are safe and that banning them would have a disproportionate effect on rural residents who have to make long journeys to the nearest abortion clinic.
“Looking at what the state legislature is doing, it becomes clear that there is no medical basis for these restrictions,” said Elisabeth Smith, chief adviser for state policy and advocacy at the Center for Reproductive Rights. “They are only intended to make it more difficult to access this incredibly safe medication and to cast doubt on the relationship between patients and healthcare professionals.”
Other legislation has sought to ban the delivery of abortion pills by mail, shorten the 10-week period during which the method is allowed, and require doctors to tell women undergoing drug-induced abortion that the process could be halfway through reversed – a claim that critics say is not supported by science.
It’s part of a wider wave of anti-abortion measures many states are considering this year, including some that would ban nearly all abortions. Supporters of the bills hope that the US Supreme Court, now by a Conservative 6-3 majority, will be open to quashing or weakening the 1973 Roe v. Wade decision that established the nationwide right to terminate pregnancies.
The laws against drug abortion were prompted in part by developments during the pandemic, when the Food and Drug Administration – by order of federal court – relaxed restrictions on abortion pills so they could be mailed. A requirement for women to pick them up in person is back, but abortion opponents are concerned that the Biden government will end those restrictions permanently. Abortion rights groups are pushing for that step.
With the rules lifted in December, Planned Parenthood in the St. Louis area would send pills for telemedicine abortions supervised by the health center in Fairview Heights, Illinois.
A single mom from Cairo, Illinois, more than two hours from the clinic, chose that option. She found out she was pregnant just a few months after giving birth to her second child.
“It would not have been a good situation to have another child,” said the 32-year-old woman, speaking on the condition that her name was not used to protect the privacy of her family.
“Being able to do it in the comfort of my own home was a great feeling,” she added.
She was relieved to be able to avoid a long journey and grateful to the clinic employee who told her through the procedure.
“I didn’t feel alone,” she said. “I felt safe.”
Medication abortion has been available in the United States since 2000, when the FDA approved the use of mifepristone. Together with misoprostol it forms the so-called abortion pill.
The popularity of the method has grown steadily. The Guttmacher Institute, a research organization that supports abortion rights, estimates that it is responsible for about 40% of all abortions in the US and 60% of abortions that occur up to 10 weeks of gestation.
“Aside from its exceptionally safe and effective track record, the fact that drug abortion is so important is how easy and private it can be,” said Megan Donovan, Guttmacher’s senior policy manager. “That’s exactly why it is still subject to severe restrictions.”
Planned Parenthood of Southwest Ohio, which also includes Cincinnati, says drug abortions account for a quarter of the abortions it offers. Of the 1,558 drug abortions in the last year, only 9% were done via telemedicine, but the organization’s chairman, Kersha Deibel, said this option is important for many economically disadvantaged women and for people in rural areas.
Mike Gonidakis, president of Ohio Right to Life, responded that “No woman deserves to be subjected to the gruesome process of a chemical abortion, possibly hours away from the doctor who prescribed her the drugs.
In Montana, where Planned Parenthood operates five of the state’s seven abortion clinics, 75% of abortions are done through medication – a huge change from 10 years ago.
Martha Stahl, president of Planned Parenthood of Montana, says the pandemic – which is increasing dependence on telemedicine – has contributed to the increase in drug abortions.
Home to rural communities and seven Indian reservations, the vast state has many women living more than a five-hour drive from the nearest abortion clinic. For them, access to telemedicine can be significant.
Greef, who sponsored the ban on telemedicine abortions, said the measure would allow providers to watch for signs of domestic violence or sex trafficking while caring for patients personally.
Still, advocates of the telemedicine method say patients are grateful for the convenience and privacy.
“Some are in bad relationships or are victims of domestic violence,” said Christina Theriault, a nurse practitioner for Maine Family Planning who can perform abortions under state law. “With telemedicine, they can do it without their partner knowing. There is a lot of relief from them. “
The group has health centers in far north Maine where women can get abortion pills and take them at home under the supervision of health care providers who communicate by phone or video conferencing. It saves women a three to four hour drive to the nearest abortion clinic in Bangor, Theriault said.
Maine Family Planning is part of a small group of providers participating in an FDA-approved research program giving women the opportunity to receive the abortion pill by mail after video meetings. Under the program, the Maine group can also send pills to women in New York and Massachusetts.
Samuels is a corps member of The Associated Press / Report for America Statehouse News Initiative. Report for America is a national nonprofit service program that places journalists in local newsrooms to report on hidden issues.