GBH | Telehealth abortion is 'revolutionizing' service in some states, including Mass.

Story Originally Appeared on GBH

By Meghan Smith and Hannah Reale

Until just a few months ago, anyone seeking an abortion on Martha’s Vineyard would have to leave the island. But that’s changed with a recent expansion of telehealth abortions, which offers a new option to people on the Massachusetts island and others across the country who face barriers to accessing abortion care.

In December, the Food and Drug Administration permanently allowed licensed telemedicine providers to prescribe abortion pills, a two-drug regimen of mifepristone and misoprostol which can be used in a patient’s first 9 to 11 weeks of pregnancy. The rule allows patients to receive the pills in the mail to their homes — and, once federal guidelines are in place, potentially at their local pharmacy.

Providers are already noticing an uptick in patients seeking out medication abortion via telehealth. It’s a little known but now widely available — and safe — option, and one that advocates say could be especially significant for people who live far away from clinics, including those in Cape Cod and Western Massachusetts. Despite the state’s progressive laws on abortion, roughly one in eight women between the ages of 15 and 44 in Massachusetts live in a county without an abortion clinic.

Advocates told GBH News the expansion could be a game changer in Massachusetts and the 30 other states where it’s allowed under local law. And as more regulations and logistics are figured out at the federal and local levels, experts anticipate that access will only expand — in states where the political will exists.

Telehealth abortion providers see increased demand

Late last year, Christie Pitney was providing abortions in Massachusetts, California and Oregon through her online practice Forward Midwifery and the international institute Aid Access. After the December change in policy, Pitney told GBH News, her patients nearly doubled: from 139 in November to 274 in December.

Telehealth providers started cropping up in Massachusetts over the course of 2021 as federal restrictions loosened under President Joe Biden's administration. The commonwealth took part in a national study that gave residents access to telehealth abortions through Maine Family Planning as early as January 2021. Abortion on Demand started offering telehealth abortions in Massachusetts in April, Forward Midwifery in May, Lilith Care in August and carafem in November.

Planned Parenthood launched its own telehealth abortion program in Massachusetts in October, and it is the only telehealth provider in Massachusetts that accepts insurance. Communication Manager Rezwana Huq said that since the change in FDA policy, more and more patients are choosing medication abortion via telehealth, especially people who face barriers to access.

“The FDA’s decision has expanded [the Planned Parenthood League of Massachusetts'] ability to increase access to abortion care for many people, especially those who face systemic barriers to care like Black, Indigenous and other people of color, people with disabilities, people in rural areas, young people, immigrants, and those having difficulty making ends meet,” Huq said.

While many declined to offer specific numbers, GBH News reached five providers who each reported an increase in telehealth abortions provided over the last few months, whether specifically in Massachusetts or across multistate operations.

“We have seen our numbers increase a bit. It's always hard to tell what causes that — as word of mouth grows in general, and [it’s] also about the understanding of telehealth medication abortion as safe across the board,” said Leah Coplon, the director of clinical operations at telemedicine provider Abortion on Demand. “I think that there’s more awareness of it as an option.”

From medication to surgical, expanding options for abortions

Despite generally broad abortion access, there are still a number of areas in Massachusetts where a person would have to travel significant distances to access in-person abortion care. For example, a person on Cape Cod would have to travel to Attleboro, Boston or Providence to visit a clinic. From Provincetown, on the tip of the Cape, it could be a 100-mile drive — assuming that person has access to a car.

“We are not Mississippi, and I would never pretend that we were,” said Rebecca Hart Holder, executive director of Reproductive Equity Now. “But there certainly are things that we could be doing better to increase access.”

Getting off the island from Martha’s Vineyard to a clinic can take a whole day. Between the costs of the procedure as well as a ferry trip, car rental and child care, “you have spent easily a thousand or more dollars,” said Terre Young, president of the board at Friends of Family Planning, which raises money to support the family planning clinic on the island.

Telehealth abortion opened up new options. At the end of last year, Friends of Family Planning helped the Health Imperatives clinic on Martha’s Vineyard purchase ultrasound equipment. Once the ultrasound confirms that the patient is not too far along in their pregnancy, they can then be referred to a doctor in Rhode Island, who prescribes abortion pills through the mail.

While providers and advocates caution that telehealth will never replace in-person clinics, they lauded the expansion as a win at a time when abortion access is being restricted nationwide. Now, telehealth abortion is federally enshrined, though 19 states have policies that require the clinician to be physically present or prohibit sending the necessary medications by mail.

“One of the silver linings of COVID, the horrible pandemic, is that it is revolutionizing abortion health care,” said Carrie Baker, a gender studies and law professor at Smith College who advises the Abortion Rights Fund of Western Massachusetts, an organization that provides financial assistance to people seeking abortions, and has written extensively about abortion access.

Elizabeth Barnes, who grew up on Martha’s Vineyard and is now president of The Women’s Centers, a group of independent abortion providers in five states, said that the lack of access on in some parts of Massachusetts is what the future of abortion access could like in America. As the conservative Supreme Court weighs a challenge to Roe v. Wade, communities and whole regions may soon be cut off from clinics, even with the new telehealth option.

“I think we want to be very careful that one option by mail for some does not beat the need for something that should be readily and safely available through mainstream medicine without shame or stigma,” Barnes said. “One does not replace the other.”

And telehealth abortion isn’t an end-all-be-all solution to access. Massachusetts’ most recent data from 2019 shows nearly 6 in 10 abortions were surgical, not medication. Patients can only get a medical abortion up to their first 9 to 11 weeks of pregnancy — after that, it must be a surgical abortion. Screenings also rule out some patients who do not qualify due to various health conditions.

And while Massachusetts doesn’t mandate ultrasounds or blood tests before an abortion, some practitioners might still require them, which would mean an in-person appointment at a local doctor’s office.

Even for those who live near clinics, some might opt for a telehealth abortion instead. Researchers and providers said patients might want the flexibility around scheduling, fewer tests or to not have to walk into a clinic — particularly if they would have to walk past protesters, or where they might be recognized in a small town.

“Stigma is still a major reality,” said Ushma Upadhyay, who conducted a study for the University of California San Francisco on the safety of telehealth abortion. “And people should be able to access these medications with dignity and privacy and in the way that they want.”

Awareness grows

In the coming months, Upadhyay expects that more details will come out about how pharmacies will dispense abortion medications, from small, family-run outlets to massive chains like CVS and Walgreens, so that patients have the option to pick up the pills in person rather than having them mailed to their home.

There are other elements still being worked out, like insurance. The price tag for a telehealth abortion is generally lower — under $300, compared to $500 to $700 for an in-person abortion — but telemedicine providers in Massachusetts don’t accept insurance, apart from Planned Parenthood. That’s a key but complicated point in the commonwealth, where state-provided insurance covers abortions.

Expanding medical abortion, Baker expects, will also raise awareness of the option. She pointed to European countries like Finland and Sweden where more than 90% of abortions are medication abortions.

A new study from the Guttmacher Institute shows that trend is already happening in the United States. More than half of abortions nationwide were medical abortions in 2020, the institute estimates, up from just 39% in 2017.

“It’s not, like, the only way to have an abortion, but it’s an important way, and I think will be increasing,” Baker said. “I think really this will be more the norm in the future.”

Young said she is glad for the expansion of medication abortion and its potential for residents on the Cape. But she says her ultimate goal is still to offer patients more options with a clinic on Martha’s Vineyard that provides surgical abortions — if she can find affordable space.

Coplon, with Abortion on Demand, agreed that in-person care is still an important part of ensuring access. “I really see telehealth as just one option for folks,” she said. “So we are very committed to making sure that our on-the-ground partners are there.”