Telemedicine paves a post-Roe path for mail-order abortion

While Roe v. Wade is at stake, telemedicine startups that offer mail-order abortion pills are scrambling to meet the growing demand for remote abortion treatments in the United States. These sleek, modern tech companies like Hey Jane, Just the Pill, and Carafem claim to offer safe, seamless, and effective remote abortion treatments.

Leah Coplon, a nurse, midwife, abortion provider and clinical operations director at tele-abortion company Abortion on Demand, told The Daily Beast that countless patients remind them of the essential nature of this digital approach — patients living with abusive partners and the surreptitiously obtaining pills, patients in rural areas of the country where getting to a clinic is challenging, young people who do not feel safe about disclosing their care needs, and people with everyday obstacles such as time off from work, childcare or transport.

For these patients, telemedicine can streamline the abortion experience and help free up space in overburdened abortion clinics. But in a polarized political landscape fraught with legal risks, teleabortion companies face the challenges of equity and access that in-person providers face. Ultimately, in a post-Roe world, tele-abortion will probably still be illegal in half the country.

However, this “21st century abortion treatment” is the present and future of healthcare, Elisa Wells, a public health expert and co-founder of the Plan C abortion pill information campaign, told The Daily Beast. The organization’s website provides information and data on various mail order abortion services organized by state. Before the leak, Place C averaged about 2,300 users per day. On May 3rd, the website recorded 56,000 visitors.

But even Wells warns that this alternative approach to abortion “is not a silver bullet. It won’t help everyone.”

In 2020, drug-induced abortions accounted for more than half of abortions in the United States. If Roe falls, that number is expected to rise. (After the SCOTUS leak broke, Google searches for abortion pills increased fivefold.)

“Unlike 1972, in 2022 we have safe and effective pills that are empowering people, and we have the technology to connect with people and give them medical and emotional support wherever they are,” Kiki Freedman , CEO of tele-abortion startup Hey Jane, told The Daily Beast. Hey Jane’s clinical team is currently treating nine times as many patients as this time last year and is strategically operating in six states that will account for the majority of the state’s post-Roe abortion volume.

“Telemedicine abortion is a bright spot in all of this — but it’s not a panacea,” Freedman said. The reality is that the fall of Roe v. Wade – and the cruel bans already in place – will be “absolutely devastating” for pregnant people, especially black and brown people, low-income people and young people, she added.

Daniel Grossman, a doctor, obstetrician and gynecologist at the University of San Francisco, told The Daily Beast that he has operated in international settings that indicate the reality of a post-Roe America. In places without access to safe, legal abortion treatment, people sometimes attempted to terminate a pregnancy using herbal remedies, were kicked in the stomach, or even inserted something in the vagina, causing some to become very ill or die. Self-administered medical abortions can help make those backyard abortions a thing of the past.

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After approving abortion pills in 2000, the Food and Drug Administration decided last December to relax restrictions — noting that teleabortion treatment is safe and effective, and allowing certified prescribing doctors and pharmacies to prescribe drugs to eligible ones to send patients.

Medical abortion involves a two-pill process. First, patients take a single dose of mifepristone, which blocks a hormone called progesterone that helps maintain pregnancy. In a standard protocol, patients then take a dose of misoprostol over a 48-hour period, which induces labor and bleeding, and emptying the embryo from the uterus. In the US, such abortion pills are approved for the first 10 weeks of pregnancy. The World Health Organization considers them safe for up to 12 weeks.

Studies show that medical abortion is about 95 percent effective at terminating a pregnancy. Less than 1 percent of cases result in complications such as bleeding or infection, making the drugs safer than over-the-counter Tylenol.

Tele-abortion is also usually a bit cheaper than clinical care, which ranges from about $400 to $1000. Hey Jane’s services cost $249, while Abortion on Demand costs anywhere from $239 to $289 out of pocket. Most teleabortion companies guarantee that patients will be seen by a healthcare provider within 48 hours.

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“Anyone who looks at what is going on in this country should be absolutely appalled that we have modern medical technology in the form of abortion pills and telemedicine and overnight shipping. And yet half of our country has states that ban it,” says Wells. “We also have research showing that this is safe, effective and patient-focused.”

Aside from cost and speed, remote care can also mitigate some potential uncomfortable dimensions of an in-person visit: enduring long waits, interacting with anti-abortion advocates, or bumping into a familiar face. Coplon said patients can take abortion pills “at home in their pajamas” or with the support of a friend or loved one — a benefit that may ease some of the potential emotional impact of having an abortion.

In states where telemedicine for abortion and mail-order abortion pills are illegal, using these services directly or assisting someone in doing so, as a provider or an individual, can land people in legal trouble. People of color, who are already the target of racist and discriminatory law enforcement practices, as well as systemic bias in accessing health care, are at the highest risk of criminalization.

However, even in states where abortion is illegal, patients can receive abortion pills in the mail from overseas providers like Aid Access. Mail order abortion pills can be shipped discreetly and can be difficult to trace, in some cases evading detection by those trying to ban their use. But going this alternative route, which operates outside of the legal and regulatory framework of the US, carries legal risks.

The Guttmacher Institute

There is legal, medical and financial support for those who wish to perform their own abortion at home. But Coplon warns that legal risks will still cause complications for some people, particularly those living in states with near or total abortion bans. The very rare complications of medical abortion can get worse when people are too scared to access things like antibiotics or IV fluids due to the risk of criminalization.

Healthcare providers can also face greater legal risks than patients. Currently, abortion providers are prohibited from providing telemedicine across state lines and from shipping abortion pills to eligible patients, but certain states such as California and Connecticut are in the process of passing legislation that could protect providers offering out-of-state abortion services.

While telemedicine shows promise, some worry that telemedicine’s lower intrinsic cost could undermine already underfunded, overburdened clinic-based care. Over the past decade, over 250 abortion clinics have closed in the United States, and six states currently have one remaining abortion clinic. Clinics are “the backbone” of abortion care, and Coplon stressed that tele-abortion companies should support them, not replace them. Many teleabortion companies, such as Abortion on Demand, donate some profits to local abortion clinics in this effort.

Telehealth abortion, and telehealth care in general, is also skewed to help higher-income, literate, and English-speakers, Coplon explained. These are key barriers to entry, as 75 percent of abortion patients are low-income. Almost half live below the federal poverty line.

With modern technology and pharmacy, abortion treatment is becoming more efficient than ever. But whether telemedicine will overcome these growing barriers and bring abortion to all patients in the 21st century remains unclear.

“With Roe’s downfall, there will be huge gaps that telemedicine alone cannot fill,” Freedman said.