Online clinics show abortion access can survive state restrictions and Roe v. Wade threat

Rachel Rebouché and Ushma Upadhyay
·5 min read

Near-total bans on abortion became law recently in Arkansas and South Carolina, suggesting a dire future for abortion rights if the Supreme Court overturns Roe v. Wade — a possibility that seems more likely than ever before. But the road ahead will not be shaped by anti-abortion legislators or Supreme Court justices alone. A different path to abortion access has emerged.

Over the past year, new virtual clinics have begun delivering medication abortion entirely remotely. Last July, a federal court suspended a Food and Drug Administration rule that requires patients to obtain the first drug in a medication abortion at a health care facility during the pandemic. That drug, mifepristone, is the only one of 20,000 FDA-regulated medications that requires in-person dispensation but can be taken at home.

The ruling created an opening for virtual clinics like Choix, Hey Jane and Just the Pill to offer “no touch” services for people less than 10 weeks pregnant. Patients complete a medical history form online, consult with a clinician over video or telephone, and if eligible, receive two medications from a mail-order pharmacy.

An ongoing study one of us is leading at the University of California, San Francisco (UCSF) demonstrates that the care offered by virtual clinics is safe and effective. The California-based company, Choix, served approximately 140 patients over two months. Patients were overwhelmingly satisfied with the service. It allowed them to have an abortion with privacy and without having to take time off work, find child care or travel long distances. One grateful patient called it a godsend to be able to go through the process while safe at home.

In front of the White House on March 09, 2021, in Washington, D.C.
In front of the White House on March 09, 2021, in Washington, D.C.

The same results bear out for Hey Jane, which provides services in Washington and New York and saw demand double week after week in the first month of operation. "I especially loved the fact that the medication came to my house via mail," said Nicollette Roe, a Hey Jane patient. "I made a plan with my partner about doing it at night, after our daughters were asleep. I had no stress around how to do everything because Hey Jane made it so that the doctor was moments … away via the app or by calling.”

At the moment, these virtual clinics cannot use mail-order pharmacies to deliver medications to their patients. That's because in January, the Supreme Court reinstated the FDA rule while litigation is ongoing. But virtual clinics illustrate the resilience of abortion care even in the face of a hostile Supreme Court or state laws designed to gut abortion rights.

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After the Supreme Court’s order, networks of advocates and providers figured out how to provide abortion outside of brick-and-mortar operations, regardless of a patient’s residence. Start-ups have found innovative ways to deliver medication abortion to patients, like Just the Pill's pop-up mobile sites. And nonprofit organizations such as Aid Access and Plan C have helped people receive medications by mail regardless of the state in which they live.

Stop unscientific abortion regulation

Remote care is all the more important given the number of states that make gaining access to abortion as difficult as possible and the prospect that the Supreme Court will abandon the core holding of Roe v. Wade. But even if Roe remains on the books, Americans in roughly half of the country live in states without meaningful access to abortion care. The expansion of medication abortion will help navigate these “abortion deserts,” or regions where patients must travel over 100 miles to reach a clinic. Virtual care can overcome the barrier of distance (and its related costs) by reaching patients at their homes and across state borders.

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This month, in deciding whether to defend restrictions on medication abortion, the FDA will consider the public health evidence that supports extending virtual services. The UCSF study and others like it provide the proof that remote care is safe and effective — without the financial, social, logistical and interpersonal constraints of clinic-based services. Over the long run, the FDA should allow studies on telehealth for abortion to proceed, enabling a formal review of the safety of direct-to-patient dispensing without the interference of politics. More immediately, the FDA should suspend the unnecessary and scientifically unsupported regulation of medication abortion.

Telehealth may well be the future of more affordable and more accessible abortion care in the first 10 weeks of pregnancy. The Biden administration must act now to help realize that future.

Rachel Rebouché (@RRebouche) is the associate dean for research and James E. Beasley Professor of Law at Temple University School of Law. Ushma Upadhyay (@UshmaU) is an associate professor and researcher with Advancing New Standards in Reproductive Health at the University of California, San Francisco, and director of research at the UC Global Health Institute's Center of Expertise on Women's Health, Gender, and Empowerment.

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This article originally appeared on USA TODAY: Online clinics are path to abortion care amid hostile laws and rulings