Last month, Missouri narrowly missed becoming the first state in the country without abortion access, when the state’s sole abortion clinic was nearly shut down by the health department. The clinic, which is operated by Planned Parenthood, remains licensed for now, but the standoff follows a slew of escalating abortion bills across the country, including one in Missouri that outlaws abortions any later than eight weeks into a pregnancy. In May, Louisiana signed a bill banning abortion as early as six weeks, following in the footsteps of states like Georgia and Kentucky.
None of these laws have gone into effect just yet, and most will likely be contested in courts for months. But all of them severely undermine abortion rights, some in states where clinics are already few and far between. Another option is abortion via telemedicine, which involves a medication abortion induced by a duo of pills: mifepristone and misoprostol. The model for telemedicine abortion varies, but patients usually consult with a physician via videoconference and undergo a handful of required exams prior to taking these pills.
But as states like Georgia limit access to abortion procedures, routes for telemedicine abortion might also be curtailed. At the very least, it’s unlikely telemedicine abortion will be expanded further or prove a viable alternative for people who have little access to in-clinic abortions. Telemedicine abortion is already barred in 17 states, all of which require that the physician in question be physically present during the procedure.
Planned Parenthood, which provides telemedicine abortions in 14 states including Georgia, uses the site-to-site model, which means patients still have to go into a health center for a video consult with a physician. For people in rural or remote areas, opting for a telemedicine abortion can cut back on multiple trips to a health center or give them an option when an in-clinic abortion isn’t an option. But the future of telemedicine abortion is restricted both by the process, which isn’t virtual from beginning to end—and the laws governing virtual consultation.
Enter TelAbortion, a trial telemedicine abortion service by research organization Gynuity that allows patients to connect with physicians from the comfort of their homes. The trial, which started in 2016, currently operates in eight states and has helped at least 370 pregnant people receive an abortion. In some cases, TelAbortion providers are physically located in one state but licensed in another, which allows them to reach clients there as well.
“We call our model ‘direct-to-patient’ because the provider communicates with the patient wherever she is,” says Erica Chong, who is co-leading the project. “So often, she’s at home, or sometimes she’s in her car on her lunch break at work. It’s really shortening that distance to getting care.” TelAbortion effectively cuts out the in-person visit required of, say, Planned Parenthood’s telemedicine abortion; patients do still need to obtain blood tests and an ultrasound, but that can be done locally.
The program is currently in what Chong describes as “liberal states”—Hawaii and Colorado, for example. (Even people in states without restrictive abortion laws don’t always have easy access to abortion clinics.) TelAbortion obviously cannot expand into states where telemedicine abortion is illegal, but one workaround Chong is exploring is to introduce the program in neighboring states. “If we can get into a neighboring state, it’s possible for a woman in Texas, for example, to maybe cross the border into New Mexico,” Chong says. “She can have her consult there, and then pick up her package at a Fedex office that’s holding the package for her, or something like that.”
The hope is to get enough providers on board so TelAbortion can eventually go from research study to full-blown service. “As a research study, unfortunately a lot of people are suspicious,” Chong says. “There’s nothing that we’re researching about the actual medications—it’s all the same medications, and they’re very effective and safe—but I think a lot of people are scared off by the words ‘research study.'”
What many people don’t realize is that medication abortion pills were approved by the FDA nearly 20 years ago—albeit with a number of restrictions—and are much more common in other countries. “Abortion pills themselves are not very well known in the U.S., and the use is very low when compared to other countries,” says Elisa Wells, the cofounder of Plan C, a platform that provides detailed information on medication abortions and reviews on abortion pill providers. “So you wonder, why is that? Why is it such a popular method elsewhere? And I think it’s in part because of the restrictions that have been placed on medication abortion.” Those regulations include not selling the abortion pill as an over-the-counter medication and requiring that providers register with a distribution company to carry the drug.
Many are now turning to online pill providers, which allows them to take charge of their bodies—and don’t require any in-person consultations or medical tests. For people in states with three or fewer abortion clinics, or who are far from healthcare of any kind, telemedicine options like TelAbortion may not be realistic (or available anytime soon). What many of them can benefit from, however, is the freedom to purchase safe, legitimate abortion pills online—something countless individuals are already doing through Aid Access, an organization selling abortion pills run by a physician named Rebecca Gomperts. (It’s also the online provider with the highest rating, according to Plan C, and offers the option of an online medical consultation.)
There’s no shortage in demand: In the past year, Aid Access received 21,000 requests from the U.S. and was able to fill somewhere from a third to half of requests. And as abortion access is compromised across the country, many pregnant people seeking abortions are confused about their options—and what might get them in trouble. Plan C compiles information on whether people can get into trouble for a self-managed abortion, so those seeking abortions in states with stringent abortion laws can feel secure in their choice.
“It’s unbelievable the hoops people have to jump through in order to get a basic healthcare service in our country,” Wells says. “But people aren’t waiting around for that. They are looking for other options. And we know that our generation of people of reproductive age is a digital generation that gets all of their services for everything online. That’s where they’re looking, and that is where they are finding self-managed abortion.”
Eventually, organizations like Plan C hope to lift some of the restrictions imposed by the FDA—though that may be a longer battle. “We even knew in 2000, when it was approved, that the abortion pill was very safe and effective—and now we have 20 more years of experience,” Wells says. “It’s safer than Tylenol, and yet we don’t have access to it. So that tells you it’s political and not based on science.”