The overturning of Roe v. Wade in 2022 restricted people’s access to brick-and-mortar abortion clinics in the United States and spurred a shift toward medication abortion. Now, abortion pills like Mifepristone represent the majority of abortions in the country, a shift made possible in part through telemedicine services.
However, we are already seeing lawmakers target telemedicine in an attempt to restrict abortion access further. Statewide abortion bans that force brick-and-mortar clinics to close are only the first step. The next step is to dismantle telehealth infrastructure and target pharmacy networks that dispense Mifepristone by mail, further keeping patients from accessing care remotely.
Even in states where abortion remains legal, there are clear attempts to create hurdles to access and to prevent doctors in those states from helping patients in states where abortion has been banned. In short: It’s a mess. Let’s break it down.
Inequality of Access in a Post-Dobbs World: SHIELD Laws and Legal Turmoil
We are already seeing the impact of overturning Roe v. Wade, which provided federal protection for abortion care. Mothers living in states that banned abortion are nearly twice as likely to die during pregnancy, childbirth, or soon after giving birth, compared to mothers residing in states where abortion is legal and accessible. Further, black mothers living in banned states are more than three times as likely to die as white mothers in those states.
Telemedicine is one of the strongest tools the states have in maintaining access post-Dobbs (referring to Dobbs v. Jackson Women’s Health Organization, the 2022 Supreme Court case that overturned Roe v. Wade). Following the ruling, many physicians turned to telehealth to try to help patients in other states, and several states created SHIELD laws to protect providers who offer abortion consultations to people located in banned states.
We are seeing significant legal turmoil as a result, with attorneys general from banned states attempting to sue out-of-state doctors. Such cross-border legal threats alone can be enough to discourage doctors from providing consultations and care. These laws are being tested in courts now.
Bans on Telemedicine-Based Abortion Create Barriers to Access
Even in states where abortion is technically legal, hurdles abound. In Arizona, abortion clinics are still open but geographically concentrated. Most are in Phoenix, with two clinics in Tucson. For people who don’t live in those hubs, getting there isn’t always feasible, especially when faced with obligations like work, school, and child and/or elder care. In addition to the logistical hurdles, there are financial considerations: taking time off work could mean lost wages, while paying for gas and an overnight stay away from home isn’t always an option.
Telemedicine could be a helpful solution, in theory. However, the state has a ban on telemedicine for medication abortion, and receiving abortion pills like Mifepristone by mail is illegal—restrictions that date back to pre-Dobbs times. Meanwhile, many other medications can be prescribed via telehealth.
To get an abortion in the state, a womb-bearing person must physically visit a designated abortion clinic and receive the medication directly from a physician (not from a nurse practitioner, physician’s assistant, or pharmacist). Furthermore, the physician must observe the patient taking the pill.
While Arizona does not criminalize a person for managing their own abortion, the state does try to obstruct access, creating logistical and financial hurdles that are essentially insurmountable—and many of which disproportionately affect people from marginalized communities.
New Legislation Creates Additional Hurdles, Even Where Abortion Pills Are Legal
Even in cases where abortion isn’t illegal outright in a state, the goal is often to be obstructive, making abortion access out of reach due to financial and logistical burdens. The government has been very slick in ensuring a number of insurmountable hurdles. Rhesus factor (RH) testing is an excellent example of this.
Rh is part of a person’s blood type, represented as the positive or negative after the letter A, B, AB, or O. If a pregnant person is Rh-negative, and the fetus is Rh-positive, the pregnant person’s immune system may create antibodies in response to the fetus’s blood, which can complicate future pregnancies. The risk of such complications can be reduced by giving patients a medication, RhoGAM, that prevents antibody formation after a birth, abortion or miscarriage.
To provide appropriate abortion care, abortion clinics need to know a patient’s Rh status. In the past, abortion clinics could do a simple finger-prick test in the clinic to determine Rh in mere minutes. If necessary, RhoGAM could be provided during the same visit.
Then, the federal government changed the complexity classification of Rh tests, deeming them too complex for outpatient clinics. Now, the Rh test requires a venous blood draw, which is then sent to an external lab, complicating the process and adding wait time. In addition to the increased time needed, this also results in additional costs due to extra lab fees.
Guess who were the only clinics running Rh testing in-house? Abortion clinics. Other medical facilities weren’t affected by the change in complexity classification, because they don’t routinely do this specific test in-house. This regulation change was framed as a neutral “safety” measure, but in reality, it targeted abortion clinics.
Abortion Access Saves Lives
No law will prevent people from getting abortions. If someone really wants one, they will get one. Obstructing or outlawing abortion is only going to put these individuals in danger, and there is no cause for it. Medical abortion has an over 95% success rate, and serious complications result in less than one-half of 1% of all cases.
There is a safe way to provide this care, and lawmakers are deliberately choosing to block it, purposefully endangering lives. Taking down telemedicine will only make a bad situation worse.
