Today, a wide range of reproductive healthcare services are available through telehealth—but only if a person has reliable internet access.
Millions of Americans lack access to reliable high-speed internet. But a move this summer from the Biden-Harris administration—a $42.45 billion investment in affordable high-speed internet—will no doubt help to close this digital divide. Promoting equity in internet access is especially urgent in a post-Roe world, where 21 states have moved to ban or restrict abortion, all while telehealth abortion capabilities are increasing.
The Broadband Equity Access and Deployment (BEAD) grant program, announced in June, is a commitment to connect all Americans to affordable high-speed internet by 2030. Created under the Bipartisan Infrastructure Law, BEAD requires states to prioritize unserved areas before improving service elsewhere. It has been equated to FDR’s historic Rural Electrification Act, for its potential effects on jobs, education and healthcare. BEAD recognizes that high-speed internet is not a luxury but a necessity, especially in rural areas: “For today’s economy to work for everyone, internet access is just as important as electricity or water or other basic services,” said President Biden.
The pandemic popularized and revolutionized telehealth, and today, a full range of reproductive healthcare services are available: abortion, contraception, gender-affirming care and more—but only if a person has reliable internet access.
“Including abortion and other sexual reproductive healthcare in the U.S. and around the world, telehealth has the possibility of reducing barriers to care while providing solutions to care across the board,” said Dana Northcraft, founding director for the Reproductive Health Initiative for Telehealth Equity and Solutions (RHITES), a nonprofit focused on bridging equity gaps in reproductive telehealth through advocacy and policy.
The Biden administration estimates 8.5 million households are without high-speed internet infrastructure, and millions more face limited or unreliable internet options. Broadband Now, a data technology company, estimates 42 million Americans have no access to broadband (defined as having download speeds of at least 25 megabits per second and upload speeds of at least 3 per second).
Approximately 36 million women of child-bearing age live in states that have banned abortion. But pro-abortion states like New York, Massachusetts and most recently California are taking bold action towards increasing access, by way of shield laws that protect telehealth providers dispensing medication abortion care to out-of-state patients. These laws quickly become “a lifeline to people in states that have cut off access to essential care,” shielding both patients and providers “from the draconian laws of those states,” said California state Sen. Nancy Skinner (D-Berkeley), who introduced SB 345, the state’s shield law.
“Telehealth offers the opportunity for people to see providers who look like you and who speak a language you do. It offers the opportunity to build that trusting relationship that is so important in delivering healthcare while also expanding health and digital literacy in innovative ways of connecting with care,” Northcraft said.
Since the FDA decision in January lifting the in-person requirement for mifepristone, there has been a 137 percent increase in abortions via telehealth. The move has made abortion care more affordable and accessible; it has also become a last resort for those seeking care in states with bans who cannot afford to travel out of state.
Telehealth will continue to flourish under this broadband expansion, which on its face, seems to be guided by equitable frameworks focused on social determinants. The BEAD investment reflects Biden’s middle-out and bottom-up approach to the economy’s growth. Treating high-speed internet like a utility will make it easier for women, people of color, LGBTQ+ and disabled people to access care—whether for contraception, abortion services, pre-natal and post-natal checkups, or gender-affirming care.
“It’s really time to transform the landscape of telehealth,” Northcraft said, “and find equitable, caring and patient-centered solutions.”
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