By Danielle Bessett, PhD., and Kelsey Mello
Advocates around the country are applauding the U.S. Food and Drug Administration’s (FDA) decision earlier this month to review its longstanding restriction on the medication abortion drug mifepristone. Medication abortion is a safe and effective method to end a pregnancy, usually in the privacy of a patient’s own home.
Yet, since 2000 the FDA has limited physicians’ ability to distribute mifepristone through telemedicine services and by mail, requiring that it be ordered, prescribed, and dispensed in a clinical setting by a certified provider, through what is now known as a Risk Evaluation and Mitigation Strategy (REMS).
Due to the COVID-19 pandemic and resulting pressures on the medical system, telehealth options have expanded broadly for a wide range of healthcare services, allowing patients to receive safe, high-quality care while preserving precious medical resources. In fact, in July 2020, the FDA temporarily suspended its mifepristone in-person dispensing requirement in response to the COVID-19 pandemic. However, this move did not significantly increase access to medication abortion in Ohio, Kentucky, and West Virginia — states that have restrictive policies limiting access to telemedicine and medication abortion services.
The Ohio Policy Evaluation Network (OPEN) examined the impact of these policies in Ohio, Kentucky, and West Virginia and found that the percent of medication abortions did not significantly increase between July and December 2020, despite the lifting of the federal REMS in-person dispensing requirement of mifepristone during this period. While the REMS is a barrier, it is just one of several hindrances to the expansion of telemedicine abortion distribution across the United States.
Kentucky and West Virginia both banned telemedicine for medication abortion in 2018. In Ohio, the law requires that mifepristone be dispensed at a clinic by a physician. Ohio has also passed a new telemedicine ban (temporarily blocked by a judge) that would require patients to attend an abortion facility at least twice: once for state-mandated counseling and ultrasound and then again at least 24 hours later to take the first of two medications.
Importantly, neither the REMS nor state laws change the location of the abortion itself, which takes place away from the facility, usually at a patient’s home between 24-48 hours after the first medication. Thus, these laws only make it more onerous and expensive to access the medication by requiring patients to travel to the facility.
Because they increase costs and travel burden, these regulations disproportionately affect people of color, people with limited economic means, people with some disabilities, and people who live far from an abortion clinic. Across Ohio, Kentucky, and West Virginia, 16 abortion facilities provide medication abortion, and all but one is located in an urban area. Telemedicine options could alleviate travel burdens for rural patients and those with other transportation barriers, such as those who do not own a car, have limited access to public transportation, or who are otherwise challenged to travel to a clinic.
Permanently lifting the federal REMS on mifepristone is an important goal. But advocates should be aware that this will not be enough to ensure access to medication abortion across the nation. A lot of work needs to be done in states like Ohio, West Virginia, and Kentucky, where abortion is heavily restricted. In order to dismantle barriers and improve reproductive autonomy for all, states must remove policies that limit access to comprehensive abortion services.
The path to ensuring access to safe abortion care during and post-COVID-19 is clear: support telemedicine for all aspects of medication abortion care, and support telemedicine as an option for patients to complete the consent process for medication and procedural abortion care. If policymakers in Ohio, Kentucky, and West Virginia are serious about preserving the rights and health of citizens throughout this pandemic and beyond, ensuring access to safe telemedicine options, including abortion, is essential.
Danielle Bessett, PhD, is an Associate Professor of Sociology at the University of Cincinnati. Kelsey Mello is a graduate student in Women’s, Gender, and Sexuality Studies at the University of Cincinnati.