Legislation pushed by anti-abortion lawmakers says the pill is too risky to be prescribed without an in-person exam.
This article was published on Wednesday, April 6, 2022 in Kaiser Health News.
By Rachel Bluth
Shortly after Dr. Mai Fleming completed her medical residency in the San Francisco Bay Area, she began working on her medical license in Texas. The family doctor had no intention of moving there, but invested nine months to master Texas medical law, undergo background checks, have his fingerprints taken and pay hundreds of dollars in license fees.
It’s a process she’s since completed for more than a dozen other states — most recently in New Mexico in February.
“Where I live is an area where abortion is really easily accessible,” said Fleming, who practices in San Francisco, Calif. “My approach has been to expand access beyond my geographic bubble.”
Fleming is part of a wave of doctors, nurse practitioners and other healthcare providers who are getting licensed in multiple states so they can use telemedicine and mail-order pharmacies to help more women abort.
But they are increasingly blocked by state regulations. Many states already restrict doctors’ ability to consult patients online or by phone and/or dispense abortion pills through mail-order pharmacies. A series of new laws could exclude them, pushed by lawmakers who oppose abortion and argue the drug is too risky to be prescribed without a thorough in-person examination.
So far this year, 22 states have submitted a total of 104 proposals to restrict medical abortions, such as banning the mailing of abortion pills and/or requiring them to be delivered in person, according to the Institute. Guttmacher, an organization that researches and defends abortion rights. Four of these proposals have already been adopted by South Dakota.
In Georgia, lawmakers are considering a measure that would require the pills to be delivered in person and prohibit anyone from mailing them. The bill, which was passed by one of Georgia’s two houses of legislature, also requires pregnant patients to present themselves in person for testing to check for rare complications and gather other information, a a common strategy that anti-abortion lawmakers have used to make medical abortion more difficult. to obtain.
“We wouldn’t be having a telemedicine visit and teaching a woman how to perform a surgical abortion,” said Bruce Thompson (R-White), the Georgia state senator who introduced the measure. “Why would we do this with pills when frankly we have a lot of doctors or medical clinics all over the state?”
If it passes, Georgia will join the 19 other states that ban telemedicine for medical abortions.
During a medical abortion, people who are up to 10 weeks pregnant can terminate their pregnancy by taking two pills over 48 hours: mifepristone, which terminates the pregnancy, and misoprostol, which expels it. The method has become increasingly popular, and more than half of abortions in the United States in 2020 were medical abortions.
Last year, the FDA made it easier for healthcare professionals to prescribe medications used in medical abortions by removing the requirement that they be dispensed inside a clinic or hospital. This allowed patients to see a certified doctor online or over the phone and get a prescription in the mail from a licensed pharmacy.
Dr. Lester Ruppersberger, a retired obstetrician-gynecologist and 2016 president of the Catholic Medical Association, opposes telemedicine abortion, saying patients should make the decision face-to-face with a doctor.
Women need testing beforehand, he said, as well as access to surgeons or OB-GYNs if complications arise later.
“If someone really wants an abortion, whether surgical or medical, and the closest facility where you can safely access that particular procedure is three hours away, then you get in your car , completely healthy, and will drive three hours to take advantage of the medical system,” said Ruppersberger, who is the medical director of two crisis pregnancy centers in Pennsylvania that provide pregnancy care while discouraging abortion.
But some abortion providers saw the FDA regulatory change as an opportunity to expand access for people in states that restrict abortion procedures and/or medical abortions.
For nearly two years, Fleming flew to Texas a few days a month to perform abortion procedures, but that ended in September 2021, when SB 8, a Texas law banning nearly all abortions after about six weeks, entered into force. Since then, similar laws have been introduced or passed in Idaho and Oklahoma.
This summer, the U.S. Supreme Court is likely to rule on Mississippi’s proposed 15-week abortion ban, a case that could end the nation’s abortion rights enshrined in Roe vs. Wade and leave the question to the States.
Today, Fleming primarily uses telemedicine to try to bring abortions to more people, despite the crackdown. Many of his patients come from states with permissive abortion rules, but live in rural areas or other areas where abortions are hard to come by.
“Ultimately, this type of work expands access for people who don’t have other options,” Fleming said. “But that doesn’t really solve the fundamental problem and the restrictions that shouldn’t exist in the first place.”
At the heart of Fleming’s argument: No matter how many providers get licensed in states that allow telemedicine and mail-order abortion orders, they can’t provide those services in the growing number of states that don’t.
“We’re getting to a point where states with favorable regulatory situations are already served,” said Elisa Wells, co-founder and co-director of Plan C, which helps patients obtain medical abortions.
After the FDA passed the new regulations last year, Wells awarded research grants to some providers to get their telemedicine practices up and running. They used the money for malpractice insurance, licensing, and other costs.
One of those doctors, Detroit-area-based Dr. Razel Remen, has since been licensed in several states. Remen performs abortions out of a clinic in Michigan and can serve patients in Colorado, Illinois, Minnesota and New York and via telemedicine.
Remen said she was inspired to take up telemedicine when she saw the work of Dr. Rebecca Gomperts, who founded a group called Aid Access.
Aid Access relies on nine US-based clinicians to provide medical abortions in states that allow it via telemedicine. To serve patients in the remaining states, the group works through a physician and pharmacy based outside of the United States; neither is subject to US regulations. Gomperts practices in Austria and prescribes abortion drugs through an Indian pharmacy.
Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, said doctors interested in providing medical abortions across state lines cannot do so. as much as if more states shut down the practice.
“These efforts to certify and train and educate more clinicians can definitely help reduce pressure on the system,” Spetz said. But “unless someone wants to try to flout these state laws, that doesn’t necessarily help.”
This story was produced by KHN, which publishes California Healthline, an independent editorial service of the California Healthcare Foundation.