The authors of a recent study quantified the number of medically unnecessary clinical visits for abortion services. They found that more than 31,000 in-person clinic visits would be averted each month if four medically unnecessary state and federal policies were repealed and if 70% of patients received no-test telemedicine abortions.1

“The goal was to quantify the number of unnecessary visits in the U.S., and in the context of the pandemic,” says Isabel R. Fulcher, PhD, post-doctoral fellow at Harvard Medical School’s department of global health and social medicine. “What we found was that medically unnecessary abortion regulations resulted in an excess of visits and contact with clinic staff and patients — about 600,000 excess clinical visits. On a monthly basis, we estimated 30,000 excess visits, and we extrapolated that to the course of the pandemic over 18 months.”

Investigators included requirements of in-person counseling sessions, ultrasounds for medication abortions, and laws that required a physician to dispense medication, Fulcher says.

“There are many regulations at the state and federal level that require a patient to have an entire extra visit — that is medically unnecessary — before abortion care,” says Sara Neill, MD, MPH, clinical fellow at Brigham and Women’s Hospital in Boston. “Many states have mandatory counseling laws, requiring in-person visits and then a waiting period. Women go to the site for counseling, sign paperwork, and then have to wait 16 to 72 hours before returning for their care.”

Ultrasound laws also result in medically unnecessary in-person visits. “Even if the patient has a documented ultrasound, the state has mandated the patient must receive another ultrasound at the clinic where the abortion is taking place,” Neill says.

Also, under current Food and Drug Administration regulations, medication abortion pills cannot be prescribed like a typical medication. “The prescriber has to be in a clinic and administer it to the patient,” Neill says. “Even if the FDA rule is suspended or removed, some state laws mandate in-person visits for dispensing of that medication.”

Researchers have studied the feasibility of remote medication abortions, but access to this remains limited to small studies, she adds.

During the COVID-19 pandemic, 11 states tried to restrict access to abortion, but none of those policies are in effect, Neill says. “A few states — New Jersey, Washington, and Virginia — made abortion care an essential service,” she adds. “But there were not policy or regulatory changes that made delivering that care easier.”

Evidence-based telemedicine abortion care could be provided to patients who are comfortable with telemedicine. This would include a healthy woman who is certain of her last menstrual period or who has had an ultrasound, and who has no risk factors, such as vaginal bleeding or pain. The patient would hold a telemedicine visit with a physician before accessing care.

“It’s clear from this study, and from seeing what happened to abortion care in general, that if some of these regulations were no longer in place, it would be easier for patients to access abortion care, including counseling,” Neill says. “They could have fewer clinical visits and fewer in-person contacts.”

Reducing in-person visits and contacts could reduce their risk of exposure to COVID-19.

Investigators used data from 2018 to 2019 on monthly abortion rates. They did not have access to 2020 abortion care data, Fulcher notes.

Also, there are no quantitative data to suggest a decrease in abortion care during the pandemic, Neill says. “Anecdotally, I’ve heard from colleagues across the country — some see an increase in volume, and some see a decrease in volume. But there’s no quantitative data to have an answer.”

“We are looking into that now, and I’m sure the numbers on that will start coming out,” Fulcher adds. “I haven’t seen any other groups publish things on that, either.”

REFERENCE

  1. Fulcher IR, Neill S, Bharadwa S, et al. State and federal abortion restrictions increase risk of COVID-19 exposure by mandating unnecessary clinic visits. Contraception 2020;S0010-7824(20)30340-1.