More pregnant people are turning to telehealth for abortion care than ever before, according to a group of abortion researchers — with nearly half coming from states like Texas that have severely restricted or entirely banned the procedure.
According to research from the Society of Family Planning, an average of about 17,000 telehealth abortions were performed each month between October and December 2023. Nearly 8,000 of that monthly count came from residents of states with significant abortion restrictions or total bans, according to the group's latest report.
The report also shows the overall number of abortions performed in the U.S. increased from 2022 to 2023 despite 14 states banning the procedure entirely after the Dobbs v. Jackson Women’s Health Organization decision that struck down Roe v. Wade.
The Society attributes that, in part, to the expansion of telehealth abortion care and shield laws that protect access to telehealth abortion care.
“Banning abortion care does not eliminate the need for abortion,” Ohio State University’s Dr. Alison Norris said. “It forces people to innovate new solutions.”
Shield laws give clinicians legal protection to offer telehealth abortion care in states that have bans on abortion. Five states enacted shield laws in 2023: Colorado, Massachusetts, New York, Washington and Vermont.
Telehealth abortion care utilizes the same medications as clinical settings. But the majority of abortions are provided in clinics, and telehealth has its limitations in states with stricter abortion laws like Texas.
Some may have medical issues that make in-person care a better option or may be past 12 weeks of gestation, in which a provider may recommend procedural abortion as the best method, Norris said. Others may just be more comfortable getting care in person.
"People need trusted in-person care locally where they live," Norris said. "They shouldn't have to drive hours to receive in person care."
In addition to some state shield laws, President Joe Biden also issued a rule last month strengthening existing privacy rules under the Health Insurance Portability Act of 1996, or HIPAA. The goal of the new rule is to protect women living in states like Texas where abortion is illegal and need to travel out of state to have the procedure legally done.
To providers like Dr. Jenny O’Donnell with the Society of Family Planning, any enhanced protection around confidentiality of sensitive data is a plus. But O'Donnell added that's not necessarily the same as extending telehealth protections into federal law.
"In a lot of ways, the Dobbs ruling has pushed this down to the state level by design and that's where the shield laws are really taking hold and are most effective," O’Donnell said. "So I think that they are complementary, but not in the same breath."
While the Society of Family Planning said it's seeing an increase in telehealth abortions, access to the medication most commonly used in those settings is still in limbo.
The U.S. Supreme Court is still deliberating Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration — a case that could weaken nationwide access to mifepristone. That’s the first of a two-drug regimen, including misoprostol, used in about two-thirds of all abortions in the U.S. last year.
The conservative U.S. Court of Appeals for the Fifth Circuit ruled last year that mail-order access to mifepristone in the country would end, but that decision cannot take effect until the Supreme Court weighs in — which could come as soon as next month.
Abortion providers say it's not the first time they've been left waiting for answers.
“We have been on edge in the past about whether we'd be able to continue to mail mifepristone," said Leah Coplon with the online abortion care group Abortion on Demand. "Many, many telehealth providers are prepared to move to a misoprostol-only protocol, if necessary.”
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