All restricting access to abortion pulls metaphorical walls closer together. On who can dispense drugs, on what clinical tests are required first, on the duration of pregnancy, the rules are all designed to delay, deter and delegitimize. It’s a Death Star trash compactor. The box around abortion is getting smaller and smaller.
It’s policy development; technology, meanwhile, tends to see boxes as something to think outside of. A long awaited to study published this week in the magazine Contraception proposes a way to circumvent the tightening of regulations: telemedicine. Abortion medication delivered by mail, administered by a practitioner working via videoconference, could safely expand the geographic footprint of clinics and providers. “Many clinics are already using telemedicine for other services,” says Elizabeth Raymond, a researcher at Gynuity Health Projects who is leading the project. “Our study confirms that this is a feasible, safe and effective approach.”
A few US states, most recently Louisiana and Georgia, have passed so-called heartbeat bills that ban abortion after about six weeks of pregnancy. But thanks to legal and other challenges, none came into effect. Yet these laws are only the most recent iterations of the restrictions that have made clinics that perform abortions extremely rare. In 27 US cities with populations over 50,000, there are no abortion clinics within 100 miles. And one of the drugs used in medical abortions is so regulated by the Food and Drug Administration that pharmacies can’t even dispense it; you have to get it at a clinic, from a provider.
Therefore, one of the main barriers to abortion is direct access. “Clinics are often overloaded. Women wait a long time for an appointment or the clinic schedule doesn’t suit their work or life,” says Raymond. “In many clinics there are protesters, and walking through them – having done it myself, as a doctor and a researcher – is daunting.”
So Raymond’s study, called TelAbortion, removes IRL from the middle of the equation. A phone call with a clinic starts the process and, depending on the state, women still need to have an ultrasound or a pelvic test, nominally to confirm the gestational age of the pregnancy. Some states require additional testing. (“It’s a lot easier to get an ultrasound or lab tests in this country than an abortion,” Raymond says.) Those test results go to a licensed provider in the woman’s state, but not necessarily located there.
Then, a provider and a patient talk to each other via privacy-compliant videoconferencing software on a computer or phone. If she qualifies and meets the standard of care for a medical abortion, the provider sends her the pills (200 mg of mifepristone and eight tablets of misoprostol at 200 mcg each—you take four, and if you don’t have bleeding within 24 hours, you take the other four).
The mail part is a bit tricky, not because of the medical results — this procedure is so safe that some people argue it should be available over the counter — but because of the regulations. Medications must be mailed to an address in the state where the provider is licensed. TelAbortion is covered by an Investigational New Drug Application, so participants can obtain mifepristone outside the walls of a clinic. Additionally, some states explicitly say that abortion cannot be administered via telemedicine and that the study must follow each state’s laws.