The practice of telemedicine—accessing care remotely from a doctor or nurse via phone or video conference to address a health need—is a rapidly growing segment of the healthcare landscape. Forbes called it a “game-changer for patients.” ANSIRH conducts research exploring the potential of telemedicine to improve access to abortion care.
Even before the COVID pandemic, abortion in the United States was becoming increasingly difficult to access as state-level restrictions forced clinics to close - leaving large swaths of the country without accessible abortion care. A 2018 study by ANSIRH researchers found that there are 27 “abortion deserts” in the US, or large cities where people must travel over 100 miles to get abortion care. Provision of medication abortion by telemedicine has the potential to fill some of those deserts, especially when combined with delivery of mifepristone and misoprostol by mail. In addition, this model has the potential to reduce risk for patients and providers during disease pandemics.
The first telemedicine abortion program began in Iowa in 2008. Between 2008 and 2015, Planned Parenthood clinics in the state performed 8,765 medication abortions via telemedicine, all following the same protocol. A patient came in to the clinic for an intake appointment, including an ultrasound, and a provider reviewed her images and medical history remotely. The provider spoke with the patient via videoconference, after which the provider entered a password to unlock a drawer in front of the patient, where the medication abortion pills were held. The patient took the first pill, mifepristone, in front of the provider via videoconference, and the second pill at home. Within two weeks, the patient returned to the clinic for a follow-up to ensure the abortion was complete.
Daniel Grossman and Ibis Reproductive Health evaluated this service and found that telemedicine provision of medication abortion is safe, effective, and acceptable to patients and providers.
This work also showed that telemedicine availability resulted in people accessing abortion services at earlier gestational ages and increased access to services for people living in remote parts of the state.