HYANNIS — A Hyannis clinic and its affiliates are the beneficiaries of a $700,000 state grant that will enable the organization to begin offering abortion pills by July.
Health Imperatives, which operates seven clinics in southeastern Massachusetts, is one of 11 community-based organizations to receive $4.1 million from the Dept. of Public Health as part of the state’s efforts to expand abortion services. The money will enable Health Imperatives, which has existed for 40 years in Hyannis, to prescribe and distribute the medications mifepristone and misoprostol. These medicines were approved by the FDA in 2000 to end pregnancies in the first 10 weeks. Mifepristone stops the flow of the hormone progesterone and misoprostol causes contractions, according to Carrie Baker, a professor of the study of women and gender at Smith College. (She wrote about telemedicine and abortions for the Independent in 2021.)
Medication abortions accounted for 53 percent of all U.S. abortions in 2020, the most recent statistics available, according to the Guttmacher Institute. That number is up from 39 percent in 2017.
The prescription service will be offered starting in July, after Health Imperatives clinics have purchased medical equipment, trained staff, conducted security assessments, and “enhanced our security measures,” said Julia Kehoe, the organization’s chief executive officer.
The clinic will need ultrasound machines and other equipment to determine the amount of time since conception. Kehoe said the Hyannis clinic currently has 10 staff members including two nurse practitioners. Health Imperatives employs two medical doctors who provide “policy guidance and sometimes clinical practice at all seven sites,” she said.
The state announced the new funding on Dec. 28; Kehoe said she needs to find out if the funds can be used to provide transportation to a surgical abortion clinic for women who are beyond 10 weeks of pregnancy. The closest provider of surgical abortions to Outer Cape Cod is Four Women Health Services in Attleboro, 110 miles from Provincetown. Some transportation funding has been allocated to other grant recipients that she has spoken with, said Kehoe.
Abortions are legal under Massachusetts law up to 24 weeks. Anyone who wishes to end a pregnancy beyond 10 or 11 weeks must seek a surgical abortion. (According to Planned Parenthood, medication abortion works about 87 percent of the time in the 11th week of pregnancy.)
Cape Cod Healthcare, which owns both Cape Cod Hospital and Falmouth Hospital, will not provide surgical abortions except “when a woman’s life is in jeopardy,” according to a statement from spokeswoman Lisa Connors. “We always do whatever is necessary to preserve the health of the mother, which includes offering abortion services,” the statement said. Connors would not comment further.
Outer Cape Health Services also does not offer either medication or surgical abortions. The OCHS spokesperson did not return a call seeking comment.
Last summer, OCHS’s Gerry Desautels told the Independent that the clinic’s providers would not write prescriptions for abortion medication but that its pharmacies would fill such prescriptions written by other providers.
A study published in the Journal of the American Board of Family Medicine by researchers at the University of California found that most primary care or family doctors, like those at Outer Cape Health Services, will not prescribe abortion medications because of layers of state and institutional restrictions. These include regulations that require abortions to take place only in surgical settings, according to the study. Researchers also found that the Food and Drug Administration’s Risk Evaluation and Mitigation Strategy requirements related to dispensing mifepristone add to the regulatory burdens.
The FDA’s regulations are a big hurdle for primary care doctors, said Kristina Shepherd, founder of Lilith Care, a Rhode Island-based company that offers the abortion pills by mail with a telehealth appointment to women living in Massachusetts, Rhode Island, and Hawaii.
State Sen. Julian Cyr of Truro said the Health Imperatives grant is a major victory for the Cape, where abortion care has not been available since 2008. Because Health Imperatives has clinics on Nantucket and Martha’s Vineyard, islanders will now be able to obtain medication abortions without getting on a boat, Cyr said.
Providing medication abortions in Hyannis will be a good way to see how many women seek them out, Cyr said. After monitoring use of the service for a year, he said, Cyr and state Rep. Sarah Peake will assess if there is a need for additional funding and political support for expanded services.
“The Dobbs decision has profoundly changed the dynamic around abortion in a very positive way,” said Cyr, referring to the Supreme Court’s striking down federal protections for abortion rights. “There was a historic fear surrounding abortion in the pre-Dobbs environment. Post-Dobbs, everyone is reassessing.”
Provincetown-based Helping Our Women (HOW) Executive Director Gwynne Guzzeau said making abortions available in Hyannis will save HOW money. The nonprofit drives women from the Outer Cape to medical appointments. It will cost less to go to Hyannis than to the Boston area for abortion care, Guzzeau said. About 40 percent of HOW’s clients are of child-bearing age; women don’t often come to HOW with reproductive health needs, she said.
“But anything that improves access to abortion care, that is huge,” Guzzeau said.