For people living on Outer Cape Cod, the nearest abortion clinics are at least two hours away. That means a trip will likely require time off from work or school and, often the need to find child care since most people who have abortions are already parents.
But a groundbreaking decision by the U.S. Food and Drug Administration (FDA) issued two weeks ago will make abortion care easier to get. The decision lifted a longstanding rule that patients could get mifepristone, the abortion pill, only by seeing their health-care providers in person. The move opens the door to expanded access to telemedicine abortion.
Telemedicine abortion allows health providers to supervise the use of medication to end a pregnancy via videoconferencing, telephone consultations, or online forms.
Two pills are used for telemedicine abortion: mifepristone, which interrupts the flow of the hormone progesterone, and misoprostol, which causes contractions. This combination of pills, which the FDA has approved for use during the first 10 weeks of pregnancy, safely and effectively ends an early pregnancy.
Telemedicine abortion became widely available for the first time during the Covid pandemic. Before that — because of anti-abortion movement pressure — the FDA tightly restricted mifepristone under a program called REMS (Risk Evaluation and Mitigation Strategy), which required practitioners to hand the medication to the patient, even though the patient takes the pills at home.
When the pandemic hit, abortion providers and medical groups sued the FDA to remove the in-person distribution requirement. In July 2020, a federal court in Maryland temporarily suspended the requirement as an unconstitutional undue burden on people seeking abortion during the pandemic. The court ruled that the requirement was medically unnecessary and could expose patients to Covid.
Shortly afterward, telemedicine abortion startups sprung up across the country and are now operating in more than 20 states. These clinics screen patients remotely using a “no-test” medical protocol based on patient history rather than in-clinic exams to determine eligibility for medication abortion. The clinician then prescribes abortion pills to eligible patients using online pharmacies that mail the pills to patients to take at home. Clinicians are available during the process, which usually takes a couple of days and resembles a heavy period.
Research proves that telemedicine abortion is as safe and effective as in-clinic care and that many people prefer it because of convenience, privacy, and cost.
After President Biden took office, he ordered the FDA to consider permanently removing the in-person distribution rule, which it finally did last week.
In Massachusetts, several virtual clinics are now offering telemedicine abortion, including Aid Access, Forward Midwifery, Lilith Care, and Maya Network — all of which offer medication abortion for $150 with an online intake form and delivery within two or three days. Aid Access offers a sliding scale for people who can’t afford the $150 fee. For video consultations, there is Abortion on Demand for $239 and Carafem for $250 to $375, with one- to three-day delivery. And Planned Parenthood of Massachusetts also recently started offering telemedicine abortion with same-day appointments.
While some will still want in-person abortion care, telemedicine is an important option, especially for people living far from abortion providers. Telemedicine care can be scheduled quickly and happen on your phone or computer wherever you are. It also allows patients to avoid protesters at clinics and to maintain their privacy.
Unfortunately, the FDA did not lift all of its abortion pill restrictions: it left in place a requirement that prescribers must be certified with the drug manufacturer. And many states in the South and Midwest still have local laws blocking access.
In Massachusetts, the FDA’s decision means telemedicine abortion is here to stay, and so is increased access to early, convenient, safe, and affordable care. As the Supreme Court appears poised to overturn the constitutional right to abortion, this development comes not a moment too soon.
Carrie Baker is professor of the study of women and gender at Smith College and a contributing editor at Ms. magazine.