In the wake of Dobbs, people living in states with abortion bans are finding creative ways to access abortion healthcare. Some are able to travel to states that still allow abortion healthcare, while others are obtaining abortion pills from telehealth providers based outside of the U.S., such as Aid Access or from U.S.-based telehealth providers using mail forwarding.
But for people living along the U.S. southern border, there’s a new option: Telefem, a telehealth abortion provider based in Mexico City that mails abortion pills to secure pickup locations along the U.S.–Mexico border for $150.
Telefem opened its doors to Mexicans in November 2021, but soon people from other countries began contacting them for help. They realized they could offer service to people from other countries who could travel to Mexico and pick up abortion pills in a safe location near Mexico’s borders, such as Guatemala to the south and the United States to the north.
Ms. magazine spoke with Telefem director and midwife Paula Rita Rivera about how Telefem works and why they began offering services to people from the United States.
Carrie Baker: Are there many telemedicine abortion providers in Mexico?
Rivera: It’s a new approach that’s recently gaining ground. Although there’s an increasing number of independent providers that are starting to use this approach, there are only three or four organizations that provide this service now.
Baker: How have things changed since the Mexican Supreme Court decriminalized abortion in September 2021?
Rivera: The September 2021 Supreme Court ruling to decriminalize abortion has improved abortion access across the country. Because of this ruling, state laws criminalizing abortion can now be challenged across the Mexican territory.
Baker: When did you start serving people from the United States?
Rivera: Just recently. We sent our first package yesterday! We noticed that people from other countries were reaching out to us and that is how we came up with the idea that people near the border could come to Mexico to pick up their packages.
We send the package to designated points of delivery in border cities. The user has to cross into Mexico to pick up her package.
Anya Rozario: Could you walk us through the process of getting the pills?
Rivera: It’s very easy and simple. Women contact us through WhatsApp. They first speak to an expert counselor who checks whether they are eligible to receive abortion pills. If they are, we explain how they will get the pills, how to use them and what is going to happen when they take them. Then they are referred to a clinician for a remote medical consultation, where they may be asked to provide more information. They are then asked to sign a consent form. After that, Telefem sends them a link to make the payment. A courier ID number is generated, which she can track in real time and see when the package will arrive at the destination that she has selected. Users can choose where they want their medication to be shipped anywhere in Mexico.
Baker: How do you mail the pills to your patients?
Rivera: There is a legal restriction on sending the medications outside of Mexico, so we send the package to designated points of delivery in border cities. The user has to cross into Mexico to pick up her package.
Baker: How many pills do you give them?
Rivera: The package contains one envelope with one 200-mg mifepristone pill, one envelope with four misoprostol pills (800 mcg) and one envelope with eight tablets of ibuprofen. We also include another envelope with extra four pills of misoprostol (800 mcg) that are to be taken in case no bleeding occurs within 24 hours of taking the first misoprostol dose.
Once the person has received their package, they talk to their Telefem provider, who walks them through the entire process. We communicate however they want—by text, call, WhatsApp, anything. Then there is a follow-up after seven days to ensure that the process was successful.
Baker: How long does it take to get an appointment once someone contacts you?
Rivera: The first contact happens immediately. It does not take more than five minutes. The time period that goes by between the counselor and the medical provider is also short and very straightforward.
Baker: Do you require an ultrasound or can somebody just tell you when their last period was?
Rivera: It depends on the assessment and clinical judgment of the medical provider. They follow the most recent WHO guidelines.
Once the person has received their package, they talk to their Telefem provider, who walks them through the entire process.
Baker: Do you require that the patient provide any sort of documentation like an ID or a driver’s license?
Rivera: No. They sign an informed consent form. This process can be carried out digitally. In case there is an underage woman 12 to 18 years old, we are required by law to have a tutor to sign for her. A tutor is not necessarily a parent. It could be a friend or neighbor, whoever she wants. Just somebody over 18.
Baker: How can people pay for your service?
Rivera: We charge $150, which can be paid by PayPal or wire transfer. We are working on accepting credit cards.
Baker: I saw on your website that you recommend that people take the pills in Mexico, rather than carrying them home to the U.S. Can you explain why?
Rivera: It’s not a requirement, but we recommend it because it’s hard to carry controlled medications across the border. People doing this may be asked to show proof they need those medications.
Rozario: Where can people pick up their packages?
Rivera: People can go to the assigned courier pick-up office, show their ID and they will give them the Telefem kit. It’s just like any other shipping package.
Baker: Then would someone from the U.S. go to a hotel for a couple days to take the medications?
Rivera: If women from other countries want to stay here in Mexico and go to a hotel, Telefem will be joining her (virtually) wherever they are.
Mexico has a huge problem of teenage pregnancy, which is reflected in the number of maternal deaths that we have in this country. Telefem is our way of giving back and decreasing maternal deaths.
Rozario: What do you do if there is a complication?
Rivera: We have a network of doctors and clinics for referral in case of an emergency.
Rozario: Do you have connections with specific clinics already established that you can recommend the patient goes to?
Rivera: Yes, Telefem has connections with established clinics and doctors with whom we have good relationships. They are along Mexico’s borders.
Baker: Is medication abortion legal in the regions along the Mexico border?
Rivera: Both medications used for medical abortion are legal in Mexico, and doctors can prescribe them across state lines. Additionally, we are protected by the Supreme Court ruling that abortion is not criminalized anywhere.
Baker: What happens if somebody is farther along than 10 weeks when they take the pill?
Rivera: Right now, we are offering the service up to 10 weeks. We offer information and counseling on other care alternatives for women beyond 10 weeks.
Baker: How many patients have you had since you started?
Rivera: We have shipped 129 packages so far. It’s really working. It’s amazing work. I’m very happy about that.
Both medications used for medical abortion are legal in Mexico, and doctors can prescribe them across state lines.
Baker: Can you tell me about your background?
Rivera: I’m a midwife, but ours is a multidisciplinary team with a spirit of collaboration for Telefem to work as it is. We put the patient at the center and that’s where our innovation really comes from. We have healthcare professionals who are giving a more human service.
Baker: On your website you talk a lot about respecting women and supporting their decisions. Why are you committed to doing telemedicine abortion care for women?
Rivera: Mexico has a huge problem of teenage pregnancy, which is reflected in the number of maternal deaths that we have in this country. Telefem is our way of giving back and decreasing maternal deaths.
It’s also very important to us that people who don’t have access or who don’t know what to do can find Telefem. We follow a personalized method, giving attention to each women. We care about the person that is seeking our services.
Baker: How does it make you feel to be able to provide this service to women who so desperately need it but often can’t get it?
Rivera: I’m happy about it. I feel good. I have hope. I think the world can change. It makes me feel like I’m giving back. It makes me feel like I’m contributing to society, and it ultimately makes me feel really happy and proud.
Baker: Do you have any final thoughts for Ms. magazine readers?
Rivera: I want to say to the women out there: We are here for you! Don’t be afraid. We are with you till the end.