In Massachusetts, Maine Family Planning is offering telemedicine abortion, operating under a research exception to the FDA restriction.
This article orginally appeared in the Daily Hampshire Gazette. It is published here with permission.
On Jan. 12, the Supreme Court reinstated a Food and Drug Administration rule requiring patients seeking the abortion pill to make an unnecessary, in-person visit to their health care providers. Despite this decision, access to abortion in Massachusetts is expanding, and not just because of the recently-passed ROE Act.
Just last month, Maine Family Planning started offering telemedicine abortion in Massachusetts, operating under a research exception to the FDA restriction.
Telemedicine abortion combines medication abortion—which uses pills to end a pregnancy—and telemedicine—which allows health providers to deliver health care via videoconferencing or telephone consultations.
“The pandemic has really amplified all of the hurdles for folks getting abortions,” says Leah Coplon, program director at Maine Family Planning. “Child care, time off from work, the cost of gas. All of those things are harder with the pandemic. Telemedicine can help eliminate some of those challenges, allowing people to get care at home and then just get pills mailed. Telemedicine has really helped to make sure that people can access the services that they want.”
Approved by the FDA for use during the first 10 weeks of gestation, medication abortion uses two types of pills: mifepristone, which interrupts the flow of the hormone progesterone that sustains the pregnancy; and misoprostol, which causes contractions to expel the contents of the uterus. Patients take the pill and pass the pregnancy at home.
This combination of pills is 95 percent effective and is an extremely safe way to end an early pregnancy. In fact, medication abortion today accounts for over 60 percent of all abortions in the first 10 weeks, according to the Guttmacher Institute.
Despite the safety of medication abortion, politically-motivated restrictions on mifepristone have blocked easy access to the pill. The FDA prohibits retail pharmacies from stocking and distributing mifepristone, instead requiring clinicians to register with the drug manufacturer and distribute the medication in person to patients, who then take most of the pills at home.
Whereas the Risk Evaluation and Mitigation Strategy program is meant to restrict dangerous drugs, mifepristone is in fact an extremely safe drug—six times safer than Viagra, which the FDA does not similarly restrict. The FDA restriction on the abortion pill is based on politics, not medical evidence.
In 2016, reproductive health research organization Gynuity Health Projects obtained an exception to the REMS restriction to conduct research on telemedicine abortion. The study, called TelAbortion, allows participating clinicians to provide medication abortion care by videoconference and mail, without an in-person visit to an abortion provider (tests can be obtained locally when needed). The study is now running in 15 states and D.C., including Massachusetts as of last month.
“We know that medication abortion is safe,” says Coplon. “Tens of thousands of people have done it over the past two decades. People take the pills at home and pass the pregnancy at home. So the only real difference that we’re adding with the telemedicine piece is that instead of having to come to a clinic to obtain those pills, they can get them through the mail. The only difference is the talking part of the visit that we’re providing via telehealth now.”
Gynuity research has shown that telemedicine abortion is just as safe as in-person care, says Tara Shochet, co-director of the TelAbortion Project at Gynuity:
“There have been many, many studies that have shown medication abortion to be highly safe and highly effective. We have seen exactly that with the telemedicine model. There is no increase in risk. There’s no lowered efficacy. It is as safe and as effective as when the provider hands you the pills. And in fact, I think it’d be very fair to argue during pandemic times it is a safer way to take it because you are not adding in the risk of COVID.”
In addition to being safer than in-person care, many people choose telemedicine abortion because it is more private, convenient and affordable than in-clinic services. Whereas in-clinic abortion in Massachusetts costs between $500 and $700, a telemedicine abortion with the Gynuity study through Maine Family Planning costs just $250.
“Anytime that we can increase access to care, that’s a win for the field of reproductive health,” says Shochet. “Especially in pandemic times, being able to provide this service is huge.”
Despite Supreme Court resistance, telemedicine is revolutionizing abortion health care in ways likely to persist long past COVID-19. The cat is out of the bag. The obstacle course of expensive, burdensome and delayed abortion is archaic. Accessible, affordable, early abortion care is possible—and inevitable.
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