ABORTION PILLS
FOREVER?
Telehealth was supposed to simplify getting an abortion. UW researchers found a messier reality on the ground, affecting in-person reproductive care in states like Washington.
WRITTEN BY MEGAN BURBANK
PHOTOGRAPHY BY MERON MENGHISTAB
[MONDAY, AUGUST 23] Even before the US Supreme Court overturned Roe v. Wade, abortion pills dominated the discourse, framed by activists in Washington State and beyond as a seamless way to maintain access should state-level policies jeopardize care.
Since Roe’s reversal in 2022, abortion pills have become central to preserving abortion access nationwide, with licensed clinicians prescribing the drugs remotely for patients in states with active abortion bans. Recent data shows that 63 percent of abortions are medication abortions, and the pills have unsurprisingly become a major target for right-wing lawsuits. But a new study from University of Washington researchers, published in JAMA Network Open, shows telehealth pill protocols are not exactly frictionless for folks living in states that have banned access to abortion, meaning in-person procedural abortions in states like Washington will likely always be needed to meet the rising demand for care.
The UW survey focused on 37 people who traveled across state lines to Kansas, a destination for reproductive health care, to get abortions. Like Washington, Kansas has upheld access to abortion, making it a sanctuary for care since Roe was overturned.
Among the 37 people surveyed, 11 found out about medication abortion via telehealth only after they’d traveled to get a procedural abortion. Twenty-six study participants were aware that they could obtain pills through the mail, but didn’t consider it. And the seven who thought about ordering pills were dissuaded by worries about legality and privacy, discouragement from others, or efforts to connect with online services that were not reciprocated. Some did not fully understand that they could obtain remote medication abortion from licensed providers.
Even beyond concerns about legality and legitimacy of pills purchased online, patients sometimes just preferred to get care in person. “For some people who knew about telehealth or getting abortion pills in the mail, they still wanted an in-clinic experience because they wanted human interaction as part of their as part of their treatment,” lead researcher Anna Fiastro told CHUM News.
These findings could have major implications for abortion providers across Washington State, who routinely provide care to patients traveling for treatment. For years, out-of-state patients have relied on Washington providers for abortion care, a dynamic that predates Roe’s reversal but has been entrenched by the proliferation of anti-abortion policies across the country in recent years. Fiastro’s findings suggest this outsized dependence on Washington abortion providers is unlikely to be reduced by the rise of telehealth.
The results of the study didn’t come as a surprise to Mercedes Sanchez, executive director of Cedar River Clinics, which provides abortions and other reproductive health care across the state. It’s served out-of-state patients for years, including out of its brick-and-mortar locations in Renton, Tacoma, and Yakima.
During the early COVID-19 pandemic, Sanchez said, Cedar River launched a telehealth program allowing patients to obtain abortion pills through the mail; they were one of the first clinics to do this. But patients also had the option to pick up pills in person, and even as health care moved broadly online, Sanchez was surprised to find patients often preferred to make the trip to the clinic.
“I think being able to interact with a person just makes it more personal, and I think it also makes patients feel more seen and heard, and gives them the opportunity to ask questions, which helps relieve any anxiety they might have,” she said.
This preference for in-person, in-clinic treatment is part of a pattern Sanchez has observed anecdotally at her clinics, one that echoes the UW study’s findings: While medication abortions were growing in popularity even before Roe was overturned, in-person options are more popular than news reports on the rise of medication abortion and influencers in the reproductive health space might have you think.
“Throughout our long history, we have found that a good number of patients, when they come in for a medication abortion, during the consent process — when they learn that a procedural abortion is basically quicker and it’s over in a day, and doesn’t require taking pills and going through the whole process of expelling the tissue at home — they often change to a procedural abortion,” she said. “They’re here and it’s completed.”
In-person care is also essential in certain medical situations, said Sanchez: whether that’s a fetal anomaly in a wanted pregnancy, a threat to the health of the patient, or the cumulative impact of abortion bans and restrictions delaying care, leading to a stage of pregnancy that precludes medication abortion (about 10-11 weeks’ gestation).
Abortion pills are “a huge help,” said Sanchez, “but there will always be a need for clinics.”
There is also a need for clear information on the potential legal consequences of obtaining abortion pills in ban states, which wasn’t always obvious to patients seeking abortion, the study found, reflecting what Sanchez described as “a public awareness education gap that is concerning.”
That gap has been fueled by ongoing confusion as laws change rapidly, according to Sara Ainsworth, chief legal and policy director of If/When/How, a reproductive rights legal advocacy group.
Misinformation also plays a role, one borne out by the UW research itself: At least one study participant had planned to take pills sent by mail, but reported being dissuaded by a woman at a pregnancy resource center, who, according to the study, warned the patient that “you never know what somebody could be sending you.” Reputable sites dispense FDA-approved medication prescribed by licensed clinicians, but pregnancy resource centers, while they resemble abortion clinics, have an agenda that doesn’t align with this reality.
Often operated by groups with ties to fundamentalist Christianity and the anti-abortion movement, these centers typically offer free pregnancy tests and counseling that employs junk science on abortion and scare tactics to coerce people into remaining pregnant. They thrive on the misinformation that feeds what the UW study characterized as “the gap between the convenience of remote access and the credibility of brick-and-mortar clinics.”
It’s a gap familiar to Ainsworth of If/When/How. If/When/How operates a repro legal helpline, which fields calls daily from people seeking advice on obtaining abortion care. “People do not know their rights right now,” she said. “Their rights are changing on a dime. They’re afraid, and they’re navigating all the things that come along in your personal life.”
Advance provision of abortion pills has been suggested as a solution to access — activist Jessica Valenti has called it “so exciting!” — but the reality, said Fiastro, is that while it’s “a great tool,” it’s also “a challenge,” as most people they talk to “aren’t planning on having an abortion in the next few years.” And when they do, said Ainsworth, they’re navigating a unique set of circumstances that dictate whether telehealth or medication abortion are practical. If someone is a minor or undocumented, travel may not be an option. In domestic violence situations, she said, clandestine travel may be easier to conceal than pills taken at home.
“We also get calls from people who don’t know if abortion is available in states where it is,” said Ainsworth, speaking of state-level restrictions on abortion and other reproductive health care. “So people are very, very confused, and it is intentional on the part of abortion opponents.”
Amid this confusion, it’s not surprising that telehealth abortion isn’t a slam dunk for patients in states with active bans. But it means that in-person care in states like Washington will continue to be critical in the coming years. Though, despite the media and activists’ emphasis on abortion pills alone, that may not be a problem in and of itself.
“It isn’t always bad for someone to choose to leave the state to get their care,” said Ainsworth. “That’s not always the bad option. That may in fact be the better option for someone, and it’s really their call. But what I think the study showed is that they might be making that call without all the information about what’s available to them.”
Since the reversal of Roe, medication abortion and telehealth have been powerful tools for patients seeking abortions in states with abortion-hostile policies, a way to safely self-manage abortion care at home. But the UW study shows access to pills remains far from universal, or universally understood. Interestingly, six study participants expressed a retroactive interest in medication abortion by mail and telehealth. They found out about remote options after they’d already traveled to receive in-person care. They would have chosen telehealth if they’d known they could.
Ainsworth said knowledge gaps like these could be addressed through broader education campaigns, to spread the word that there are safe channels through which patients can access pills online, and receive remote counseling from licensed clinicians and FDA-approved medication. If that information can reach patients in ban states before they need to travel, it might lessen the burden of care on clinics in states like Washington, and make the experience less stressful for patients.
“I didn’t know that was an option,” said one participant of telehealth abortion services, “or I would have done that… I wouldn’t have traveled at all.”
Megan Burbank is a writer and editor based in Seattle. She specializes in reporting on abortion policy in the absence of Roe v. Wade. She’s contributed to The New Republic, Slate, The Nation, The Wall Street Journal, The Seattle Times, NPR, and daily papers and alternative newsweeklies across the country.
Meron Menghistab is a South Seattle-based and -raised photographer working primarily in narrative structured work. He is the Art Director of CHUM News.
This article is published in collaboration with RANGE Media, a worker-owned newsroom based in Spokane, WA. Read more about our partnership.