Abortion clinics expanding virtual options during pandemic

Charlie Neibergall/AP Photo

Abortion providers say they’re seeing heightened demand for telemedicine abortions during the coronavirus pandemic, and providers are preparing for a growing number of virtual visits as social distancing measures continue.

These clinics are looking to video call apps like Facetime and AI-powered chatbots to make prescribing abortion medication almost entirely virtual during the pandemic. Some providers are dialing back in-person visits and forgoing ultrasounds and pelvic exams they’ve typically required before prescribing abortion pills virtually.

But while much of the health care system has quickly shifted to online visits in recent weeks with encouragement from the Trump administration, abortion providers say longstanding federal and state restrictions will ultimately limit how much of their care can be provided online.

FDA rules mean most patients must still pick up pills to terminate a pregnancy in-person, sometimes driving across state lines multiple times to do so. In some states, patients must still make two separate in-person trips, one for a consultation and another to pick up the pills.

One nonprofit that's studying whether abortion medication can be safely mailed to patients, cutting down on in-person visits, said it's now seeing more patients. Gynuity Health Projects, which operates its FDA-reviewed trial in 13 states, reported a 30 percent increase in virtual visits at some clinics between February and March as shelter-in-place orders took hold. Patients can receive the abortion drugs without ever having to leave their homes after a video consultation with providers participating in the trial.

The trial is “particularly well suited to a lot of these stay-at-home orders” said Erica Chong, a director at Gynuity.

Twenty-one Democratic state attorneys general, along with Democratic lawmakers and abortion rights advocates, have pushed the FDA to loosen restrictions on abortion drugs during the pandemic, arguing that abortion is an essential service that can't be put off like elective procedures during the health crisis. But the agency under the Trump administration is unlikely to approve the request.

“By blocking this critical service, the government is forcing women to have to go outside of their homes and expose themselves to the virus,” said New York Attorney General Tish James.

Conservative lawmakers and activists opposed to abortion have also lobbied the FDA to maintain the limits, warning that the few women who may experience complications from the pills will be a burden on medical resources during the pandemic.

“With hospitals pushed to their limits by the Covid-19 health emergency, we should minimize, not increase, unrelated pressures on health care providers,” said Sen. Cindy Hyde-Smith (R-Miss.).

Abortion providers have been prescribing abortion medication virtually for years in some states. Under some state laws, patients must take the pills in a doctor’s office or clinic under the supervision of a provider who watches through a video hookup. Generally, patients must also submit results from an in-person ultrasound or pelvic exam before they can get a virtual prescription.

The drugs are safe and effective in just the first 10 weeks of pregnancy. And federally funded research has found that medication abortions administered remotely have no higher risk of complications those conducted in-person.

But of the eighteen states that had existing bans on virtual abortions, many have sought to cut off abortion access entirely during the pandemic. They say it would endanger public health and use up scarce medical gear to have patients coming into clinics for the procedure. Those states haven’t eased off their telemedicine restrictions.

Abortion providers say they’re expecting to see more patients from Texas, Arkansas and other states that adopted pandemic abortion bans requesting telehealth appointments. However, many of those patients must travel to a state that allows telemedicine abortions even for a virtual appointment. Providers in some of those states have asked the courts to loosen those bans during the health crisis, arguing the limits pose a health risk by forcing patients and doctors to sometimes travel long distances for in-person consultations that could otherwise be done from home.

“It’s quite a hardship,” said Julie Burkhart, the president of the Trust Women network that operates clinics in Oklahoma and Kansas. “We've seen people drive hours and hours and hours for a medication abortion.”

Planned Parenthood said it doesn’t yet have the data to know whether more of its patients are receiving telemedicine abortions, but it’s taking steps to make the process easier. While patients must video chat with abortion providers and pick up the medication from inside a clinic, its affiliates are piloting a new AI-driven chatbot that texts patients after they’ve taken the medication to cut down on non-urgent visits.

Social distancing has also pushed abortion providers in states that don't require ultrasounds to rethink whether imaging or pelvic exams are always medically necessary before prescribing the medication. Twelve states require that providers perform ultrasounds on each abortion patient, according to research nonprofit the Guttmacher Institute. But providers in other states may forgo those measures if they believe they have enough data to safely prescribe medication and that an in-person examination could put a patient at risk, said National Abortion Federation Medical Director Alice Mark.

“It’s something many, many of our clinics are looking into right now because that’s obviously a point of contact within the clinic,” said Mark, who is an obstetrician.

Carafem, a clinic with locations in Georgia, Tennessee, Illinois and the Washington, D.C., area, plans to sign up more of its providers for the Gynuity trial to test home delivery of abortion medication, said Chief Operations Officer Melissa Grant. The Gynuity trial has drawn many patients to Carafem from Alabama, where laws are more restrictive.

“As long as you have technology available, we have connection and we have enough medical providers, it would be feasible to potentially serve significantly more clients,” Grant said.