Looking for an abortion clinic during the summer, a New Yorker in her twenties turned to a crisis pregnancy center. The Christian-affiliated center only tried to scare her out of the process, said staff of the provider she eventually used.
Searching Google, the woman stumbled upon TelAbortion – a research project that began in 2016. It has allowed more than 1,300 women like this to undergo medical abortion without having to visit a clinic and currently operates in 13 states and Washington, D.C.
Fearful of coming into contact with someone exposed to COVID-19, patients are less willing to visit doctors and clinics. Many health care providers have turned to telemedicine, allowing access via video link or phone call.
In some cases, that includes women who found themselves unwillingly pregnant in the midst of the pandemic.
“We’ve definitely seen our numbers explode since March,” said Erica Chong, a director at Gynuity Health Projects, the New York City company sponsoring the study.
The increase results in part from adding four states to the project – Iowa, Maryland, Illinois, and Washington, D.C. – during the health crisis to expand access, Chong said. But it also reflects that “the need has been greater and as people found us, it’s just snowballed.”
In fact, Chong said, “the number of packages we have sent during March to August 2020 is 645” – almost half the total number of packages sent since the project began.
After a woman enrolls, one of 12 affiliated providers contact her; in New York, it’s Maine Family Planning. A doctor and patient have a 20- to 40-minute consultation via video chat; then the patient receives any required screening tests, such as ultrasounds or blood tests, and receives the necessary medication in the mail.
Mifepristone and misoprostol, the drugs used to terminate a pregnancy through medication, are approved by the Food and Drug Administration, but mifepristone must be taken in a doctor’s presence. TelAbortion can legally mail the medication directly to the patient, because the safety of taking abortion medication at home rather than in a clinic is what the research project seeks to assess.
And due to COVID-19 safety concerns, screenings were bypassed, in some cases. The FDA requires them, Chong said, but most women don’t need them and “you can forgo a test that will risk a patient’s health.”
In fact, the New York City woman who received her abortion through TelAbortion didn’t have any risk factors; technically she did not need an ultrasound, said Nicole Mathieu, abortion care specialist at Maine Family Planning. But the woman had an ultrasound at the crisis pregnancy center, an unnecessary expense for someone who didn’t have insurance.
Such tests, which can cost several hundred dollars, can sometimes hinder a woman’s ability to get an abortion; not all insurance plans cover them and not all women are insured.
Though costs vary for a TelAbortion at different locations, Maine Family Planning charges $250 to participate in the study, not including tests, said Leah Coplon, a certified nurse midwife and the program director of Maine Family Planning. But cost is not the only barrier women face.
“All of the hurdles that already make abortions so difficult, the pandemic heightened,” said Coplon. “It impacts marginalized folks the most.”
A woman may have a more difficult time traveling to a clinic during a pandemic. TelAbortion eliminates that obstacle. A woman doesn’t need to find childcare while she heads to an appointment. She can even have her video appointment while on her lunch break in her car, Coplon said.
Most women report positive experiences with TelAbortion. “Some people might think it’s distancing,” Chong said. “But most patients love it and providers like seeing patients in their own setting.”
Alice Mark, medical director for the National Abortion Federation, says that medication successfully completes an abortion about 98% of the time. “Interest is up, use is up, people have seen research and understand that it works,” said Mark. But 2% of women will bleed heavily or still have symptoms of pregnancy and will need to see a doctor to be evaluated, and possibly take additional medication or have an aspiration procedure.
But the drugs worked effectively for the New York woman. Because she initially had trouble finding care and spent money on transportation and unnecessary testing, Mathieu said, “Having medication delivered to her door was a huge help.”
(Photo by Nicole Mathieu)