HYANNIS — Six months ago, Health Imperatives became the only clinic on Cape Cod to offer medication abortion, ending the Cape’s 15-year period as an abortion care desert. Now the organization, like others around the country, is facing a threat that could hinder its current approach to care.
The U.S. Supreme Court in December agreed to hear a case brought by an anti-abortion coalition, the Alliance for Hippocratic Medicine (AHM), that seeks to restrict abortion by challenging the FDA’s approval of mifepristone, one of two pills used in most medication abortions. The court is expected to begin hearing oral arguments on March 26.
Health Imperatives prescribes mifepristone along with misoprostol — to be taken 24 to 48 hours apart between 6 and 10 weeks of gestation. This regimen now accounts for more than half of abortions nationwide, according to the Guttmacher Institute.
Mifepristone, which blocks progesterone, was initially approved as safe and effective for terminating pregnancy by the FDA in 2000 and has been endorsed by the World Health Organization, the American College of Obstetricians and Gynecologists, and the American Medical Association. Current data at the Guttmacher Institute show that mifepristone is now approved for this use in 96 countries around the world.
Health Imperatives Director Julia Kehoe told the Independent that, if necessary, the organization’s clinics would continue offering medication abortions in the form of misoprostol alone.
According to 2020 research published in the National Library of Medicine, misoprostol-only abortions are safe during the first trimester of pregnancy, with an efficacy rate between 85 and 95 percent.
According to Kehoe, the Health Imperatives Hyannis clinic has prescribed medications for 45 abortions since July and for 175 across its seven locations in southeastern Massachusetts.
Kehoe told the Independent last summer that the organization received 500 doses of mifepristone after Mass. Gov. Maura Healey issued an executive order to stockpile the medication across the state. Healey’s order followed a ruling in Amarillo, Texas, where U.S. District Judge Matthew J. Kacsmaryk — a Trump nominee with anti-abortion views — is the sole sitting judge, according to the Texas Tribune. That move initiated the fight over the drug that has reached the Supreme Court.
If AHM’s lawsuit succeeds, the Court’s decision could limit access to the medication even in states like Massachusetts, where recent legislation aims to safeguard providers from national attacks on reproductive care. The ruling could prohibit mifepristone from being prescribed through telehealth and mandate that only physicians may write prescriptions for the drug, even in a state where physician assistants, nurse practitioners, and nurse-midwives can all provide abortion care.
According to Kehoe, all 45 medication abortions prescribed at the Health Imperatives center in Hyannis included visits to the office, though some patients opted to take the pills at home.
When patients come in with a pregnancy with a gestational age beyond the 10-week window, the clinic works with them, Kehoe said, referring patients elsewhere for procedural abortions. Procedural abortions are legal in Massachusetts up to 20 weeks and six days of a pregnancy.
The closest provider offering procedural abortions is Four Women Health Services in Attleboro, 111 miles from Provincetown.
To help abortion-seekers from the Outer Cape with logistical challenges, Health Imperatives used a grant from the state Dept. of Public Health last summer to hire “navigators,” Kehoe said. They work to reduce stress by helping arrange for transportation and hotel stays if needed, she said.
Kehoe said that telehealth is also available for those who can’t make the trip. But strict eligibility requirements already exist for telehealth services, according to Dr. Danielle Roncari, vice president of medical services for the Planned Parenthood League of Massachusetts.
To qualify for a prescription by telehealth, a patient’s last menstrual period must have occurred within 11 weeks and the patient can’t be in any pain, because that might indicate a potential ectopic pregnancy or another complication that could require direct medical intervention.
Still Just One Clinic
The question remains as to why Health Imperatives is still the only health center on Cape Cod to offer abortion services. Some other providers cite the Hyde Amendment, which prohibits the use of federal funds for abortion care.
“We are just following the federal guidelines,” said Dr. Arshiya Seth, chief medical officer of the Community Health Center of Cape Cod, which runs five clinics on the Upper and mid-Cape.
But federal guidelines don’t prohibit abortions outright, according to guidance by the Reproductive Health Access Project, a national network of primary care providers working to expand abortion, contraception, and miscarriage care.
As a federally qualified health center, the Community Health Center of Cape Cod qualifies for specific reimbursement under Medicare and Medicaid. While the Hyde Amendment restricts these types of centers from using federal funding for abortion care, other funds can support this care, according to the Reproductive Health Access Project.
Outer Cape Health Services, also a federally qualified health center, first cited the Hyde Amendment last year in explaining why it does not offer prescriptions for abortion medications. It changed its answer to say the reason is that its clinics are focused on primary care. OCHS Communications Director Gerry Desautels told the Independent on Jan. 18 that there has been no change since.
Cape Cod Healthcare, the parent organization that operates both Cape Cod Hospital and Falmouth Hospital, also restricts abortion care.
In a statement provided to the Independent by Communications Manager Lisa Connors on Jan. 8, Cape Cod Healthcare confirmed that it provides abortions only “when a woman’s life is in jeopardy” and “to preserve the health of the mother.” An ethics committee is not involved, the statement said. The decision is reached privately between patient and provider.
If an abortion is not “urgent,” the statement continued, the pregnant patient is referred to “providers with a greater degree of expertise.”
