What is a telemedicine abortion?

A telemedicine abortion is very similar to a medical abortion administered in a clinic (where a patient takes two pills to terminate the pregnancy). 

Normally, the patient would travel to a clinic for a consultation with a doctor licensed to provide the abortion pill. The patient would take one pill at the clinic and a second pill at home, a few days later. 

With a teleabortion, the patient and doctor utilize videoconferencing to determine eligibility for a medical abortion. Instead of taking the first abortion pill at the clinic, both pills are mailed to the patient’s home. 

Is telemedicine abortion legal?

Telemedicine abortion is currently legal in 13 states (Hawaii, Washington, Oregon, New Mexico, Colorado, Georgia, New York, Maine, Iowa, Minnesota, Illinois, Maryland, and Montana).

Many residents of states near the 13 that are taking part in the TelAbortion study can get access to online abortions as well. 

To legally get a telemedicine abortion, a woman simply needs to be in a legal state for the video conference with a doctor and provide an address in that same state as to where the pills can be mailed.

Many women who live in Texas (where abortion access is heavily restricted) drive to the neighboring state of New Mexico for the virtual consultation and can get the pills mailed to a hotel room. Before the TelAbortion program, women would often need to spend several nights in a hotel, incurring costly expenses. 

Controversy Surrounding TelAbortion

Of course, there’s considerable controversy surrounding online abortion bans — especially in states where abortion ban cases have reached the Supreme Court in 2020. 

The COVID-19 outbreak has only worsened access to abortions — especially in states that have restricted access to abortion to begin with. Many outpatient clinics have been forced to shutter their doors, as most hospitals have canceled non-essential surgeries and procedures.

The American College of Obstetricians and Gynecologists released a statement in March 2020:

“Some health systems, at the guidance of the CDC, are implementing plans to cancel elective and non-urgent procedures to expand hospitals’ capacity to provide critical care.

“Abortion is an essential component of comprehensive health care. It is also a time-sensitive service for which a delay of several weeks, or in some cases days, may increase the risks or potentially make it completely inaccessible. The consequences of being unable to obtain an abortion profoundly impact a person’s life, health, and well-being.”

According to Dr. Daniel Grossman, an OB/GYN in California, “Abortion is essential healthcare and it’s safe. The arguments attempting to close clinics based on conserving personal protective equipment (PPE) are not based in evidence. What we should be doing is expanding access to telemedicine provision of abortion during this pandemic.”

But while abortions that take place in health care clinics have been the subject of attack in states across the country, critics have remained relatively quiet about telehealth abortions. Possibly, because these abortions are only legal in 13 states — where women’s rights lean extremely liberal anyway. 

While many states are fighting to restrict access to abortions during the COVID-19 pandemic, The Food and Drug Administration (F.D.A.) under President Trump has allowed online abortion studies to continue.

Though that doesn’t mean that TelAbortions haven’t been under fire at all. A 2020 proposed bill, the Teleabortion Act was read twice in February and referred to the Senate Judiciary Committee.  

How do you know you a telemedicine abortion is right for you?

An online abortion is not the best course of treatment for everyone. The most common circumstances in which teleabortions are recommended are where the patient:

• Lives in a rural area
• Cannot seek treatment due to the coronavirus
• Was a victim of sexual assault and/or incest
• Fears abortion stigmas (and crossing picketing lines of protesters)
• Lives too far away from an abortion clinic
• Lives in a state where teleabortion is legal
• Lives in a state where abortion restrictions are tight but can drive to a state (and stay overnight) where teleabortion is legal
• Can receive mail in a state (the address of a friend, relative, hotel, or post office) where teleabortion is legal 

Where can you get telemedicine abortion treatment?

Currently, 13 states have legalized telemedicine abortions. If you don’t live in one of these states, it’s possible to travel to a neighboring one for access to the abortion pill via video conference. 

While TelAbortion supervises the study and the program overall, abortions are facilitated by different organizations in each state. The largest organizations include Planned Parenthood, Carafem, Emma Goldman, and various state family planning healthcare providers. To take part in the study, contact the organizations in the following states.

In the United States, it’s extremely difficult for residents of Alaska to get an abortion while clinics are closed due to the coronavirus — and there are no states nearby to offer online treatment. 

Georgia, Illinois, Maryland 

Carafem operates online reproductive health centers in Georgia, Illinois, and Maryland. The organization also organizes services for women who live in Missouri and Ohio to cross state lines for online consults and to receive medication. 

If you live in a state where TelAbortion is illegal, contact the National Network of Abortion Funds or the closest telemedicine health care abortion provider to see if you qualify for financial aid to cover the costs of the abortion pill and expenses, such as hotel stays. 

You don’t need to travel to the clinic itself; just simply cross state lines for the online appointment and provide an address where the clinic can mail the abortion pills (a hotel address is fine). 

Colorado/New Mexico

If you live in Colorado or New Mexico, all TelAbortions are facilitated by Planned Parenthood Rocky Mountains. The clinic also organizes for women who live in Kansas, Arizona, and Utah to cross state lines for online abortions. 

Hawaii

TelAbortions are extremely important in Hawaii, where women would previously need to take a flight to get to the closest abortion clinic — if they didn’t live on the big island. All online abortions are facilitated by Hawaii Women’s Health Research Clinic. 

Iowa

The Emma Goldman Clinic provides online abortion services for Iowa residents as well as residents in neighboring Nebraska, Missouri, and Kansas (as long as they cross state lines for the consult and pills).

Maine/New York

Residents of Maine and New York can contact Maine Family Planning to receive online consults and abortion pills in their respective states. Residents of New England can travel to Maine or New York for online consults and pills while residents of Pennsylvania can travel to New York for services. 

Minnesota

If you live in Minnesota, contact Planned Parenthood of the North Central States; this facility also helps residents of Idaho, North Dakota, and South Dakota cross state lines for online consultations and pill delivery.

Montana

Montana residents can contact Planned Parenthood of Montana for telehealth abortion services. This clinic also serves residents of North Dakota, South Dakota, Wyoming, and Idaho (as long as they travel to Montana for the online consultation and to receive the pills). 

Oregon/Washington

Oregon and Washington state residents can contact OHSU Center for Women’s Health in their respective states for online consultations and access to abortion pills by mail. Residents of California and Nevada often travel to Oregon, and residents of Idaho often travel across the border to Washington to access services. 

How does medication abortion work?

Right now, there are three types of abortion: surgical, suction, and medication — otherwise known as the abortion pill.

What is the abortion pill?

The abortion pill is actually two pills, mifepristone and misoprostol. Mifepristone blocks the body’s production of progesterone, a hormone that is necessary to help continue the pregnancy. After the first pill is taken, the second pill, misoprostol, must be taken within 48 hours; this pill empties the uterus. 

The F.D.A. first approved abortion through medication back in 2000. The abortion pill is appropriate for abortions within the first 10 weeks of pregnancy. 60% of women who seek abortions choose this option. After 10 weeks, a woman must choose another viable option if she chooses to go forward with an abortion. 

According to the F.D.A., mifepristone must be given to patients by a hospital or clinic (it is not available via a prescription). Though, the F.D.A.’s mifepristone guidelines don’t specify that the pill needs to be administered at the hospital — or even in person, for that matter. 

Normally, a woman would take the first pill in the clinic or hospital and the second pill at home. 

How does the abortion pill work?

The first pill, mifepristone, blocks progesterone, a hormone that allows the pregnancy to develop. The second pill, misoprostol, empties the uterus. 

Most women do not experience pain or discomfort from mifepristone; many women experience cramping with misoprostol, though some do not. The cramping resembles that of a heavy period. There is also heavy bleeding while the uterus is emptied (for several hours), though the fetus is smaller than a grain of rice at this point, so women don’t actually notice when the tissue exits the uterus. 

Bleeding can last for up to two weeks.

Depending on the clinic, women will receive a discreet package (with only a name and address printed on the exterior) with pills, instructions, tea, peppermint, heavy-flow maxi pads, prescription pain killers, antibiotics, and nausea medication.

How long does a telemedicine abortion take?

Telemedicine abortions take about 48 hours in total. The first pill has no side effects and can be taken anywhere (work, car, hotel room, etc.). The second pill needs to be taken about two days later (within 48 hours of the first pill). Women often take the second pill at home, as bleeding can last several hours. 

All-in-all, an online abortion generally takes about 48 hours with active time taking only a few hours. Of course, it can take longer if a woman needs to travel out of state for a consultation and mailing of pills. 

Patients then schedule follow-up appointments with doctors to ensure the safety of the mother. There is also an around-the-clock toll-free support line to help women work through any related emotional struggles. 

How safe is the abortion pill?

The abortion pill is extremely safe. A Princeton study showed that only 1% of women who had medicinal abortions experienced adverse side effects. According to Reuters:

“Of the 233,805 abortions during the study period, 385 women had a serious side effect, including 238 who sought ER treatment, 135 who were admitted to the hospital, 114 who had a blood transfusion and 57 who required intravenous antibiotics. All of those women survived.”

How effective is the abortion pill?

The abortion pill is extremely effective. According to Planned Parenthood, “For people who are eight weeks pregnant or less, it works about 94-to-98 out of 100 times.”

If the pill doesn’t work, ​telemedicine patients can always seek an abortion in a clinic for aspiration to complete the termination of the pregnancy. 

How safe are online abortions?

According to TelAbortion’s clinical study in an article in the New York Times, “of the 611 completed abortions documented through April 22, most were accomplished with only the pills and without complications. In 26 cases, aspiration was performed to finish the termination.”

In some rare cases, women developed fevers or infections that require medical attention. In these cases, 46 women sought help at an emergency room or urgent care center — though these women would have been directed to do so whether or not the abortion was at home or in a clinic. Two women sought medical treatment that was not related to the pills and 15 of the women who went to the emergency room didn’t need treatment at all. A few were prescribed more anti-nausea and anti-pain medications. 

Only three of the women were hospitalized, and two received successful treatment. 

It’s also important to note that online abortions are much more effective and safe than self-managed abortions — which are on the rise, according to the Guttmacher Institute. 

In these instances, women find abortion drugs online and are subject to faulty medical advice, unknown substances in pills, and complications. Many women living in Texas cross the border, where abortion pills are sold over-the-counter (and don’t require safety follow-ups). 

A 2008-to-2009 study recruited a sample of 1,425 women to participate in a survey on self-induced abortion methods.

“The most commonly reported methods were medications (n=12), including vitamin C, aspirin, laxatives, oral contraceptives, hormonal injections, and unspecified pills or injections (but not misoprostol). Among those who used hormonal medications to self-induce, several believed that high doses of contraceptives could cause a miscarriage.”

Are there side effects of telemedicine abortion?

The most common side effects of telemedicine abortion are cramping and bleeding from the misoprostol; most women don’t experience side effects from mifepristone. 

Rarer side effects may include:

• Infections
• Fevers
• Excessive bleeding
• Blood clots
• Pelvic pain
• Allergic reaction to the medicine

Women are advised to seek medical assistance if there has been no bleeding after taking the misoprostol, experience overly excessive bleeding, extremely large clots, excessive cramping, a fever, nausea, vomiting, and/or diarrhea for longer than 24 hours after taking the second pill.  

It’s also important to note that some women experience extreme nausea that results in vomiting the second pill (rendering it useless). 

The abortion pills don’t have any long-term effects, so future pregnancies aren’t affected. 

How much does a TelAbortion cost?

An abortion through TelAbortion costs around $200-to-$375 for the online consultation and pills. The ultrasound and lab tests are extra and not provided by TelAbortion — though women can get these medical services at any provider, regardless of their state of residence. 

TelAbortion is now waiving its requirement for an ultrasound during the COVID-19 pandemic in the case women are turned away for the service. 

Depending on the patient’s state of residence, teleabortions may be covered under private insurance and/or Medicaid plans. Women who face financial hardship can seek help through abortion grant networks, like the National Network of Abortion Funds.

If you need an abortion and live in one of the 13 states where teleabortion is legal, contact TelAbortion to find out if you are eligible. If you live near a state where such services are legal, we recommend contacting the organization to see if you qualify for an abortion grant or if it’s possible to drive to a nearby state where such abortions are legal.