Telehealth and Mail Order Do Not Delay Use of Abortion Medication
Patients who met with reproductive health providers via telehealth and received medication abortion pills through the mail used the medication in a similar time frame as people who visited clinics in person, according to a recent study.1
Investigators analyzed 2,600 records of patients who took mifepristone at an average of 49 days of gestation and seven days after first contact with a clinician. They found that first contact to dispensing was similar across methods, with six days for in-person visits and five days when mailed.
“When compared to people who get their medications in person at a clinic, people who use telehealth and get their medications delivered to them by mail are not significantly delayed in having their abortions,” says Ushma Upadhyay, PhD, MPH, study co-author and a professor at the University of California, San Francisco.
The FDA was concerned that telehealth for abortion care might result in people taking their medication much later in their pregnancy, which could slightly increase their risk of complications, she explains.
Researchers found that telehealth abortion care did not delay people taking the pills, partly because patients did not have to wait as long for a telehealth appointment as they did for an in-person visit.
“Telehealth can get people in sooner to see a clinician,” Upadhyay says. “Those few additional days of waiting for the medication to arrive by mail did not prolong the process overall.”
Upadhyay and colleagues found that it took less than half a day for a patient who visited the clinic to receive their abortion medication from the clinic vs. five days for patients who scheduled telehealth visits and received the pills from a mail-order pharmacy. They studied cases during the COVID-19 pandemic when it was difficult for people to travel long distances and visit clinics in person.
“An additional telehealth benefit was it reduced people’s risk of infection,” Upadhyay says. “The data came from 14 clinics across the United States, and it included two virtual telehealth clinics that don’t offer in-person care.”
Telehealth for abortion services is beneficial to patients, but its biggest barriers are state abortion bans that do not allow those states’ residents to obtain telehealth visits and mail-order abortion pills in their states.
“They can’t take advantage of this innovation in care,” Upadhyay says. “In addition to states that have abortion bans, an additional number of states have bans on telemedicine for abortion, specifically.”
Patients in those states would have to travel to clinics for in-person care. But where telehealth for abortion services is permitted, its use can help ease some of the backlog and congestion from an influx of patients traveling to receive abortion care. “Telehealth is addressing a lot of surges we’re seeing in states where abortion has remained accessible and legal,” Upadhyay explains. “For example, Illinois has a very successful telehealth program, so people who are living in Illinois can use it.”
This helps reduce the effect of surges of patients from other states, and it reduces the waiting lists, Upadhyay says.
Even in abortion-ban states, some patients are finding ways to obtain telehealth abortion care and mail-order pills through international organizations and other means. “There are some people that are using creative ways and workarounds to get the pills,” Upadhyay says. “They may have a friend in another state and have the medications mailed to their friend.”
There also is mail forwarding, in which a person can have pills sent to a mailbox in the state that permits mail-order abortion medication. That mail center can then forward it to the person’s home state.
Clinics protect themselves legally by saying patients must be in the state where they’re providing care, but they do not necessarily have a way to confirm a patient’s address.
Workarounds are not a solution. “It’s a special population that has access to resources that can avail of those creative methods,” Upadhyay says. “You have to be knowledgeable and have resources.”
In states like Kansas, where abortion clinics are open but telehealth services for abortion are not allowed, it is much more difficult for providers to keep up with the influx of out-of-state patients, Upadhyay notes.
“Providers have said they’re doing a lot of triaging on the phone with patients calling from Texas and who are six to seven weeks pregnant, and they’re told to call back in a week or two,” she says. “It’s heart-wrenching because we know from research when people decide they want an abortion, they want it as quickly as possible.” It also is safer and more successful if the abortion is earlier in the pregnancy.
Abortion restrictions affect different groups of people differently. “These restrictions are going to impact those who are most vulnerable and those who are historically excluded from healthcare, including poor people, women of color, and adolescents,” Upadhyay says. “These are people who have many barriers to care even without these abortion restrictions.”
- Koenig LR, Raymond EG, Gold M, et al. Mailing abortion pills does not delay care: A cohort study comparing mailed to in-person dispensing of abortion medications in the United States. Contraception 2023;109962.
Patients who met with reproductive health providers via telehealth and received medication abortion pills through the mail used the medication in a similar time frame as people who visited clinics in person, according to a recent study.
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