- A first-of-its-kind telemedicine abortion pilot has begun in four states, giving women an opportunity to receive their medications by mail and speak with a doctor from their own home.
The project, developed by New York-based Gynuity Health Services, launched in Hawaii, Oregon, New York and Washington. An abortion clinic in each state is sanctioned to mail the abortion drug mifepristone to in-state patients in their first nine weeks of pregnancy who have undergone an ultrasound and blood test. The patient would then consult with a clinician via remote video on how to take the drug.
Some 23 percent of abortions performed in the U.S. in 2011 were non-surgical, or medical abortions. Advocates say this type of abortion could best be handled by telemedicine, especially in areas where access to a clinic is minimal, restricted or in some cases dangerous.
The pilot is being conducted under an Investigational New Drug Application filed with the U.S. Food and Drug Administration.
Current FDA rules restrict the drug – also known as Mifepruex – to clinical settings, specifically excluding pharmacies, so that it can’t be prescribed or mailed. That has given rise to a form of telemedicine abortion called “the Iowa model,” in which the patient visits a clinic and consults via telemedicine with a clinician in another location. In that setting, the clinician examines the patient remotely, consults with a nurse or healthcare worker at the patient’s bedside, then decides whether to approve the use of mifepristone, which is in a locked cabinet at the clinic that can be remotely opened by the clinician.
A Planned Parenthood clinic in Iowa performed the first telemedicine abortion in 2008. In that first year, the number of sites able to offer telemedicine abortions increased from six to 17, and the procedure was deemed fully effective in almost 99 percent of the 233 cases.
The concept is certainly controversial, and Iowa’s Supreme Court shot down a state challenge to ban telemedicine abortions just last year. In all, 19 states have banned abortions by telemedicine, either specifically or by mandating that a clinician be physically present when the process takes place. Others, like Kentucky, have taken steps to restrict the process.
The project is being launched with little to no fanfare - still, hackers attacked a website launched by Gynuity for the project, forcing the company to change hosts. Among the opponents is the group Americans United for Life, which has argued that at least 14 women have died as a result of taking the abortion drug (an FDA report said there was no conclusive evidence linking mifepristone to those deaths).
In a recent article in JAMA Internal Medicine, the authors – who include Elizabeth G. Raymond, MD, and Erica Chong, MPH, of Gynuity Health – say the upcoming pilot and attempts to expand the Iowa model to other states “will help to improve access to abortion, especially in circumstances in which obtaining this basic healthcare or otherwise inconvenient, intimidating or entirely infeasible.”
The article cites a 2008 survey which found that 31 percent of patients in rural areas traveled more than 100 miles for abortion services, and laments “hundreds of new restrictions on abortion (around the country), including limits on the construction of facilities, the qualifications for clinicians, and the procedures that are used for abortion.” In addition, the article noted, four states have only one abortion clinic, while Wyoming has none.
According to the JAMA article, direct-to-patient telemedicine has been an option in some 90 counties since 2016, serving about 50,000 women. It was launched in Canada in 2012, and in 2015 was introduced in Australia, serving more than 300 women to date (the paper’s third author, Paul Hyland, is with the Sydney-based Tabbott Foundation, which launched that program).
“It’s the future,” Esther Priegue, director of counseling at Choices Women’s Medical Center in Queens, N.Y., where the first of the pilot programs launched last week, told The Guardian. “Especially in the times we’re living in today, women experience so many struggles getting through our doors. They’re mothers. They work. Imagine if they could do it all from home, and never have to step into the clinic for even a moment.”
As noted by The Guardian, the pilot may encounter some other challenges. It’s not known if doctors will perform ultrasounds or conduct blood tests if they know that their services would enable the patient to get an abortion. In addition, some patients might find it more expensive to take those tests at a location other than an abortion clinic, or they might not follow through with the procedure once they get the drugs in the mail.
The study will also look at whether insurance plans cover telemedicine visits and reimburse at the same rate for in-person visit, and whether the telemedicine abortion process proves more or less expensive over the long run for patients.