Distance affects use of telehealth to access abortion pills

The distance between a patient’s home and an abortion-services facility where they would seek care significantly influences how they receive birth-control medications, according to a study published Jan. 8 in the American Journal of Public Health.  

“Basically, the farther the patients resided from an abortion facility, the more they were depending on the pills being mailed to them,” said Dr. Emily Godfrey, a UW Medicine OB-GYN and family medicine physician. She was the paper’s co-lead author.  

The research began at the start of the COVID-19 pandemic, when receiving abortion medication via telehealth and through the mail was novel, Godfrey said. Over the study span and beyond, “there was exponential growth” of patients opting to receive their pills via telehealth and the mail, Godfrey said.  

The research was conducted between 2020 and 2022, before the U.S. Supreme Court’s Dobbs decision, which overturned the constitutional right to an abortion.  

The investigators acquired electronic medical record data from Aid Access users in 21 states and Washington, D.C. Aid Access is a nonprofit that works with clinicians across the country who provide patients with FDA-approved abortion pills. Western states included in the study were Washington, Idaho, Oregon, California, Alaska and Nevada. 

The researchers tallied telehealth requests for medication abortion from 8,411 individuals. 

“With abortion now banned or highly restricted in 22 U.S. states, telehealth abortion services are necessary to maintain essential reproductive health services,” the authors concluded in the paper. 

The authors used the Centers for Disease Control and Prevention’s (CDC) county-level Social Vulnerability Index to better understand the socioeconomic status of those who requested Aid Access services. The study authors found that people living in lower socioeconomic counties had a higher likelihood of seeking medication abortion via telehealth compared to persons living in higher socioeconomic counties.  

Researchers found that, for every 100 miles of distance from an abortion facility, the per capita probability increased by 61% that a patient would access abortion medication via telehealth. Patients accessing telehealth to obtain medication abortions now constitute 20% of all U.S. abortions, the authors noted.  

In total, medication abortions comprise 63% of all abortions in the United States, according to the Guttmacher Institute.  

Most individuals who obtained a medication abortion via telehealth were 20-29 years old, did not have children, and were at less than 6 weeks gestation. More than half of the total fulfilled requests went to individuals in four states: California (21%), New York (17%), Nevada (10%), and New Jersey (10%).  

“This study gives us an idea of the sheer volume of patients using these services,” said  Anna Fiastro, a UW Medicine researcher in family medicine and co-lead author of the paper.  

The study confirms that the demand for abortion pills mifepristone and misoprostol has increased over time as more patients turn to telehealth and the mail in response to tighter state restrictions, Fiastro said.  

“I think it is remarkable that many using the mail and telehealth option were under six weeks of pregnancy duration,” Fiastro said. This finding, she added, reflects that this type of access is quick, cost-effective and safe. More of the telehealth users (51%) said they chose this option because of its low cost, compared with an in-clinic visit.  

During the two-year study period, telehealth medication abortion requests that did not require in-clinic testing jumped by 15 times, to more than 1,000 requests a month, the authors noted. This represented one-third of all virtual abortions before the Dobbs decision.  

As of March 2024, beyond the study period, licensed U.S. physicians are fulfilling close to 10,000 requests per month in states with abortion restrictions or bans, the paper stated.  

Maintaining access to abortion medication is a “critically necessary healthcare service,” the authors asserted. “Especially for individuals who are young, socially vulnerable and live in counties far from abortion facilities.”