Telehealth won't solve abortion access in a post-Roe world

Abortion pills offer a sliver of hope in a post-Roe world. But online providers face a lot of the same limits that exist in the offline world.

A person looking at a phone with information on Mifepristone.

“Telehealth is not a panacea,” said Cindy Adam, CEO of the telehealth clinic Choix.

Photo: Olivier Douliery/AFP via Getty Images

Almost as soon as Politico broke the news Monday that the Supreme Court is poised to overturn Roe v. Wade, searches for “abortion pills” shot up on Google. Reproductive rights advocates quickly held up medication abortion as the tiniest splinter of hope that pregnant people will not have to return to the back alleys of old to have abortions in a post-Roe world.

And in a lot of ways, that’s true. The telehealth boom of the last two years and more recent regulatory changes at the FDA have launched a batch of startups that provide safe, effective abortion pills by mail.

But the people behind these companies are equally cautious about overselling their promise, as they grapple with what the court’s decision means for their own nascent industry.

“Telehealth is not a panacea,” said Cindy Adam, CEO of the telehealth clinic Choix, which launched in 2020. “If you can’t provide a surgical abortion or an in-clinic abortion in that state, you also cannot do a telehealth abortion.” If Roe is struck down, that will include a lot more states.

Far from a salvation, telemedicine abortion providers view themselves instead as a stopgap for what is bound to be a surge of demand for abortions in states where it’s still legal. Without telemedicine, they say, that demand could easily exceed capacity at brick-and-mortar clinics.

Kiki Freedman, CEO of the telehealth provider Hey Jane, which operates in six states, has already seen an increase in patients reporting longer-than-expected wait times at in-person clinics. “[This] suggests to us that bans in places like Texas are already having a ripple effect,” Freedman said. “Losing Roe would only magnify that.”

Freedman and Adam hope their services will free physical clinics up to serve patients who either aren’t eligible for or open to a medication abortion.

But for people in states where abortion is banned, accessing these online services legally will require overcoming the same obstacles that exist in the offline world, including traveling to a neighboring state where abortion is legal and paying out of pocket for a procedure that can cost more than $200. “If patients can travel to the states we’re in and remain there for their visit and the time it takes the pills to get here overnight, we can provide that service,” said Leah Coplon, director of Clinical Operations at Abortion On Demand, which operates in 21 states. “Obviously not everyone has the luxury.”

Questions also remain about how much liability out-of-state providers will face if they treat patients who travel from states where abortion is banned, and whether telemedicine providers will be able to seek referrals from brick-and-mortar clinics in those states. In a state like Texas that has outlawed aiding and abetting an abortion, even something like providing information about where to get abortion pills can be legally risky for providers. If states with trigger laws on the books mimic Texas’ approach, Adam said that could further hamper Choix’s ability to serve those patients, even when they’re traveling out of state. “It would be a state-to-state question,” she said. “It will not be an easy answer.”

Lawmakers are now trying to turn their states into safe harbors for abortions, introducing legislation that would shield providers from being held liable for performing abortions on people from out of state. Connecticut recently passed one such bill and California, where Hey Jane and Choix are based, recently had a similar bill introduced in the state assembly. But even these bills wouldn’t free telemedicine providers in those states to mail pills far and wide. They would also only protect telemedicine providers when they perform abortions within Connecticut and California.

“Doctors who see patients in California and those who receive care in California should not have to fear that they will be sued as a result of abortion care enshrined in our constitution,” said California assemblymember Rebecca Bauer-Kahan, who chairs the Assembly Select Committee on Reproductive Health. “This bill shores up the legal pillars for abortion rights in California so no one within the state is threatened by outside legal attacks.”

Coplon hopes that lawmakers in other states who are supportive of abortion rights will push similar legislation forward in their states.

Despite the legal challenges of offering these telemedicine services in the U.S., there are ways to get abortion pills by mail from overseas providers, most notably Aid Access, throughout the U.S. But going that route requires patients to take on additional legal risk that domestic providers are working hard to avoid. “Our goal is to ensure our patients aren’t criminalized for this activity and also to protect our providers,” Adam said.

Perhaps the biggest obstacle facing telemedicine abortion providers in the U.S. will be merely spreading the word that these services are still available, after the Supreme Court issues its decision. Laws like the one passed in Texas have already made people wary of even seeking information about abortion care, let alone getting one, Adam said. The Supreme Court decision stands to do even more damage. “People are going to think abortion is illegal in this country,” Adam said. “The fear will be a lot greater.”

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