HYANNIS — Since 2008, it has been impossible to get an abortion on Cape Cod. But as of last week, just over a year after the Supreme Court’s Dobbs decision, there is an oasis in this local care desert.
With a $700,000 grant from the state Dept. of Public Health, Brockton-based Health Imperatives is now offering medication abortion at all seven of its locations, including in Hyannis.
“We’ve provided comprehensive sexual and reproductive health care, including options counseling, for decades,” said Health Imperatives CEO Julia Kehoe. “Adding this medication makes it easier for us to integrate that into our clinics rather than always having to refer it out.”
The medication abortion procedure consists of two pills taken 24 to 48 hours apart: mifepristone, which blocks progesterone to stop the pregnancy from progressing, and misoprostol, which flushes out the uterus through cramping and bleeding similar to a heavy period.
The FDA first approved the drugs for abortion in 2000 and authorizes them for safe use through the first 10 weeks of pregnancy. Over half of all abortions in 2020 were medication abortions, according to the Guttmacher Institute.
In April, after a federal judge in Texas overturned the longstanding FDA approval of mifepristone, Gov. Maura Healey issued an executive order to stockpile the medication in Massachusetts. Acquiring doses from that inventory was easy, Kehoe said.
Health Imperatives currently has about 500 doses of mifepristone.
“I am relieved and thrilled that these abortion services can be offered on Cape Cod again,” state Rep. Sarah Peake said. “Perseverance pays off.”
Health Imperatives “moved heaven and earth to get this done,” state Sen. Julian Cyr said.
When patients call the clinic, a counselor walks them through the process. After meeting with a nurse practitioner or a doctor, patients receive the mifepristone, which can be taken at the clinic or at home, as well as the misoprostol to take one or two days later. Staff will follow up after a few days by phone, Kehoe said.
Other providers can also refer patients to Health Imperatives for medication abortion, which Kehoe said has already happened.
Abortion medications are not prescribed at Outer Cape Health Services. Spokesperson Gerry Desautels repeated the false assertion that Outer Cape Health Services cannot offer abortions because it is a federally qualified community health center and therefore subject to the Hyde Amendment. The Hyde Amendment does not prohibit such centers from providing abortion services altogether.
Last August, OCHS issued a statement backing away from its claim regarding the prohibition, stating that it did not offer abortion care because its current focus was “core primary care and behavioral health access.”
Cape Cod Healthcare also does not offer abortion services, except “when a woman’s life is in jeopardy,” according to a statement released last September. CCH Communications Manager Lisa Connors told the Independent that “nothing has changed since then.”
Every major insurance company in Massachusetts covers medication abortion, Kehoe said.
Before launching the service on July 3, Health Imperatives staff underwent additional training not just on medication abortion procedures but also the safety protocols required to operate an abortion clinic.
“Tele-abortion services” allowing people who can’t make it to a clinic to receive the medications in the mail are a possibility, Kehoe said.
“Access is our number one priority in terms of providing health care in areas where it isn’t easy to get to the clinic,” Kehoe said — like the Outer Cape, where Hyannis is about an hour’s drive away.
Those needing an abortion after the 10th week of pregnancy must travel off Cape for care. Health Imperatives will connect these patients to a clinic that provides surgical abortions. Kehoe said they’re working closely with the Eastern Massachusetts Abortion Fund to cover costs of transportation or the procedure itself. The nearest clinic to the Cape offering surgical abortion is in Attleboro, 110 miles from Provincetown.
Outer Cape-based nonprofit Helping Our Women provides free transportation to and from health-care appointments in Hyannis and elsewhere. Women of reproductive age, usually defined as under 49, constitute a minority of their clientele, according to Executive Director Gwynne Guzzeau. But as they work and raise families, “their lives are part of the hidden story of what it’s like to be here year-round,” Guzzeau said.
Locals should know that Health Imperatives “is a safe place to go” and “an important partner and important resource in the community” despite the distance, Guzzeau said.
Sen. Cyr said he is curious to see data on the use of these expanded abortion services and the resulting scope of demand for surgical abortion, as well as where people seeking care are located. The data “will hopefully inform us about how to expand and buttress resources” for the Outer Cape and beyond, he said.
Health Imperatives won’t release any use data for the first six months, Kehoe said.