A study published in the American Journal of Public Health on January 8 has revealed that the distance between a patient’s home and an abortion services facility plays a crucial role in the growing use of telehealth to obtain abortion medication. According to Dr. Emily Godfrey, an OB-GYN and family medicine physician at UW Medicine, “the farther the patients resided from an abortion facility, the more they were depending on the pills being mailed to them.”
The research, which began during the early days of the COVID-19 pandemic, explored the use of telehealth and mail services to access abortion medication. Dr. Godfrey, a co-lead author of the paper, noted that the study observed “exponential growth” in the number of patients opting to receive abortion pills via telehealth and mail, a trend that continued beyond the initial study period.
Conducted between 2020 and 2022, the study took place before the U.S. Supreme Court’s Dobbs decision, which overturned the constitutional right to an abortion. Researchers gathered electronic medical record data from Aid Access, a nonprofit organization that collaborates with clinicians to provide FDA-approved abortion pills to patients across the country. The study included participants from 21 U.S. states and Washington, D.C., focusing on regions like Washington, Idaho, Oregon, California, Alaska, and Nevada.
A total of 8,411 individuals were surveyed for their telehealth requests for medication abortions, with findings indicating a marked increase in telehealth use as a result of distance from abortion facilities. According to the study, “for every 100 miles of distance from an abortion facility, the per capita probability increased by 61% that a patient would access abortion medication via telehealth.”
As access to in-person abortion services has become more restricted due to state-level bans or limitations, telehealth has become an essential avenue for maintaining reproductive healthcare access. The study’s authors assert that “telehealth abortion services are necessary to maintain essential reproductive health services,” particularly in states where abortion has been banned or severely restricted.
The study also looked into the socioeconomic status of those using Aid Access services, using the CDC’s Social Vulnerability Index. The findings showed that individuals from lower socioeconomic counties were more likely to seek abortion medication via telehealth compared to those from higher socioeconomic areas.
The study found that patients who sought telehealth medication abortions were predominantly young adults between the ages of 20 and 29, with most having no children and being less than 6 weeks pregnant. More than half of all requests for medication abortion came from just four states: California (21%), New York (17%), Nevada (10%), and New Jersey (10%).
Anna Fiastro, a UW Medicine researcher in family medicine and co-lead author of the paper, highlighted the sheer volume of patients using telehealth for abortion medication, stating, “This study gives us an idea of the sheer volume of patients using these services.” She also pointed out that the use of telehealth and mail services has steadily increased as more patients look for accessible options due to stricter state regulations.
The study also noted that many patients turned to telehealth options because of their low cost. Over half (51%) of telehealth users indicated that the low cost of telehealth services, compared to in-clinic visits, was a key factor in their decision to opt for this option.
Dr. Fiastro emphasized that the findings suggest telehealth and mail-accessible abortion services are not only quick and safe but also cost-effective, making them an attractive option for individuals seeking early-term abortions. “I think it is remarkable that many using the mail and telehealth option were under six weeks of pregnancy duration,” she said.
The use of telehealth for medication abortions surged dramatically during the study period. By the end of the study, telehealth requests that did not require in-clinic testing increased 15-fold, with more than 1,000 requests a month. This represented about one-third of all virtual abortions before the Dobbs decision.
As of March 2024, telehealth medication abortion requests have continued to rise, with licensed U.S. physicians fulfilling nearly 10,000 requests per month in states where abortion is heavily restricted or banned.
The authors of the study assert that maintaining access to abortion medication is a “critically necessary healthcare service,” particularly for young, socially vulnerable individuals living in counties far from abortion facilities. As state-level restrictions on abortion continue to rise, telehealth options are increasingly becoming an indispensable method for ensuring that people can still access the reproductive healthcare they need.
In conclusion, the study reinforces the importance of expanding telehealth and mail-in abortion services, especially in areas where access to physical abortion clinics is limited. Ensuring that patients have reliable, cost-effective access to abortion medication is essential to preserving reproductive rights, particularly for those who are most vulnerable or live in remote regions.
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