PROVINCETOWN — Despite Massachusetts laws protecting access to abortion, logistical and institutional barriers persist for Outer Cape residents seeking care.
Most abortions in the U.S. today are early in pregnancy: 94 percent occur within the first 13 weeks of gestation. That’s partly because the two-drug regimen of mifepristone and misoprostol have become the most common method of terminating a pregnancy.
Doctors at Outer Cape Health Services, a federally funded health clinic, do not prescribe these medications for abortions, however. As the Independent has reported, OCHS clinicians won’t prescribe them because a law known as the Hyde Amendment, passed in 1976, prohibits the use of federal funds for abortion care.
Those who get prescriptions for the medications elsewhere face another barrier here. CEO Damian Archer confirmed on Feb. 27 that OCHS pharmacies do not stock mifepristone, one of the two drugs in the regimen. This is the pill that stops the development of the pregnancy by blocking the hormone progesterone.
On the Outer Cape, the CVS stores in Provincetown and Orleans are the only retail pharmacies filling prescriptions for mifepristone.
Making One Pill Harder to Get
Mifepristone was approved by the Food and Drug Administration in 2000 and has been endorsed as safe and effective by the World Health Organization, the American College of Obstetricians and Gynecologists, and the American Medical Association. But in 2024, anti-abortion activists tried to limit access to mifepristone by arguing that it should not have FDA approval.
The Supreme Court in 2024 upheld that approval in FDA v. Alliance for Hippocratic Medicine, but anti-abortion activists are continuing the effort against it. In January, U.S. District Judge Matthew Kacsmaryk, a Trump appointee in Texas, allowed attorneys general in Idaho, Kansas, and Missouri to move forward with an updated version of the same suit.
The other drug, misoprostol, which helps the body expel fetal tissue after the pregnancy has been halted, has never been as tightly restricted as mifepristone because it has several other common uses, including as a treatment for stomach ulcers.
While OCHS pharmacists can dispense misoprostol, they can do so only if the patient’s prescription does not explicitly state that its use is for abortion. Otherwise, Archer said, “this may be considered providing abortion services.”
“We can inform patients that they have options such as another local pharmacy if we do not have a medication that they are in need of,” added Archer. “We do not refer patients for services or medications used solely for the purpose of an abortion because our operations for both the pharmacy and the clinical sites are funded by federal dollars.”
What to Expect When You’re Not Expecting
Dr. Nicola Moore, a Truro resident and experienced abortion provider, has worked in various states with fluctuating and often restrictive abortion laws, including Texas, South Dakota, and Florida.
In June 2022, she was practicing at a Planned Parenthood clinic in Waco, Texas when the Supreme Court’s Dobbs v. Jackson Women’s Health Organization overturned the Constitutional protections established by Roe v. Wade. Last month, she started commuting to an abortion clinic in Raleigh, N.C., where abortion is permitted up to 12 weeks.
Moore said that some patients underestimate the physical toll of a medication abortion. “When I talk to people in the clinic, some people don’t take seriously how unpleasant the process will be,” she said. “It’s often a very unpleasant several hours. It requires time and rest. Don’t be shocked if you’re absolutely miserable.”
Moore also said it’s important to monitor symptoms post-abortion. “One of the big indications of whether your abortion has been successful is if you don’t feel pregnant anymore,” she said. Persistent symptoms like nausea, sore breasts, or lack of heavy bleeding could signal an incomplete process. That’s rare, Moore said, but in such a case, “you should follow up.”
For Outer Cape residents, in-person abortion care options are limited. The closest provider is Health Imperatives in Hyannis, which has been prescribing medication abortions since July 2023.
Patients past the 10-week, 6-day medication abortion limit are referred to Four Women Health Services in Attleboro or Planned Parenthood in Boston. Massachusetts law permits abortions up to 20 weeks and 6 days, though legislation has been introduced that would remove limits on third-trimester abortions and make abortion broadly legal at or after 24 weeks, which can be necessary in cases of certain fetal abnormalities and in cases of maternal life endangerment. A report published in February 2024 by KFF (formerly the Kaiser Family Foundation) describes abortions at or after 21 weeks as uncommon and representing only 1 percent of all abortions in the U.S.
Since opening, the Health Imperatives Hyannis clinic has provided medication abortions to 201 patients. Across its seven southeastern Massachusetts locations, the organization has prescribed medication for 935 abortions in the last 18 months, according to Executive Director Julia Kehoe.
While telehealth options exist, most patients prefer in-person care, said Kehoe. Only one of the abortions prescribed at the Hyannis clinic was through telehealth.
Health Imperatives employs two state-funded navigators to help patients with logistical challenges, including transportation and financial assistance. “Every single person speaks with a navigator to make sure this is what they want to do,” Kehoe said.
For patients unable to afford the medications, Health Imperatives ensures they still receive care. “That’s never an issue, and we don’t want anyone to be worried about that piece of it,” Kehoe added.
Massachusetts Medicaid (MassHealth) covers abortion care, and organizations like the National Network of Abortion Funds can assist those without insurance to find local abortion funds.
Nationwide, medication abortion accounted for 63 percent of all abortions in 2023 in states without restrictive policies, according to the Guttmacher Institute, a research and policy organization committed to reproductive health and rights. A recent study by the institute found that one in four women is expected to have an abortion in her lifetime.
