Filling out a simple online questionnaire is a quick way to get 15% off your next order at your favorite online retailer. It’s also how more and more people are accessing abortions, a share that’s likely to keep growing unless the Supreme Court makes an unexpected ruling this June.
Here in Massachusetts, new estimates show that about 1 in 7 abortions now happen via telehealth, with patients getting prescribed medication from afar and getting pills mailed to them. It’s a meteoric rise considering that, just four years ago, telehealth abortion wasn’t even an option in the United States. That rate is slightly behind the national statistics of 1 in 5, as of last December.
“It’s definitely gone up quite steeply,” said Kiki Freedman, who runs Hey Jane, an online-only telehealth abortion provider that operates in Massachusetts and 19 other states. “It has really become a very critical and significant part of the access ecosystem.”
That ecosystem was upended two years ago, when the Dobbs v. Jackson Women’s Health Organization decision rolled back the federal right to an abortion and created a patchwork of laws.
The Supreme Court will once again soon weigh in on abortion access, and the ability to prescribe an abortion via telehealth at all is at stake in a new case that will be handed down in June. The lawsuit centers on the availability of mifepristone, one of the two drugs used in a typical medication abortion.
In 2023, a Texas judge initially ruled that the FDA had erred in its initial approval of the drug back in 2000, prompting state leaders like Gov. Maura Healey to stockpile the drug. That ruling, however, was put on pause and narrowed as the federal government appealed the decision.
Close court watchers agree the Supreme Court is unlikely to revert back to prior restrictions on mifepristone. But if they were to, they could roll back the COVID-era change that let abortion medication be prescribed via telehealth, mailed to a person’s home or picked up in a pharmacy.
If the justices restrict mifepristone in any way, it would be the first direct change to limit abortion in Massachusetts since Roe v. Wade was overturned in 2022. Abortion would still be legal, but potentially harder to access than it is now.
Future of access still up in the air
Some telehealth abortion providers use an online form, while others use methods like phone calls or videochat before prescribing abortion pills.
How exactly a court ruling could impact those options is up in the air, as Health Quarters’ executive director Kristie Monast explained.
“It’s a million different things depending on what the ruling is,” said Monast, whose three health centers offer abortions on the North Shore.
For Monast’s chain of clinics, the most significant change would likely be returning to the in-person dispensing model of medication abortion, rather than being able to mail the drugs to people’s homes. Health Quarters is one of many clinics that has started offering telehealth abortion since it became a permanent option in late 2021.
“We offer all of our patients, when they’re calling in and scheduling a medication abortion, the option to do either a telehealth appointment or to do an in-person visit,” she said.
So far, relatively few patients have taken HealthQ up on their offer to have the medication prescribed virtually. They’ve provided a total of 180 patients with abortions via telehealth since December 2021, Monast said, a small fraction of the more than 1,500 abortions the clinics provide each year.
Melissa Grant is the COO of carafem. Carafem offers telehealth abortion in states including Massachusetts and has in-person health centers in a handful of cities. She told GBH News many of their patients take advantage of the telehealth option when it would cost too much to travel to the nearest brick-and-mortar provider, or they have small children they can’t get a babysitter for. That’s an idea bolstered by WeCount data that shows telehealth is much more popular in rural states like Montana and Wyoming.
“Those things can be very difficult, and telehealth has decreased that necessity of going to the provider,” Grant said. “It’s like the provider comes to them.”
Telehealth option has changed the access landscape in Mass.
While many providers declined to share specific numbers with GBH News, it’s clear that the shape of abortion care in Massachusetts has changed dramatically with the rise of telehealth. Online-only providers are a key element in that transformation.
Hey Jane has provided more than 1,100 abortions in Massachusetts since the launch of its local telehealth services last June, a company spokesperson said — opting for the “asynchronous” online model, with an online form and exchanging messages for a provider to get the information they need for a prescription. That made it one of the largest abortion providers in Massachusetts, out of the roughly 18,000 Massachusetts abortions each year.
Hospitals largely do not offer telehealth abortion as a service, including Boston Medical Center, Tufts Medicine and Mass General Brigham, their spokespeople told GBH News.
Some but not all local clinics do offer abortion by telehealth, like Health Quarters, Health Imperatives on the South Shore, Cape and Islands, and the Planned Parenthood League of Massachusetts. Planned Parenthood provides more than half of all abortions in Massachusetts, but between last April and this March, provided more than 400 telehealth abortions through calls and mailing the pills to patients’ homes.
Providers still feel uncertainty
While Massachusetts residents would still have widespread access to abortions, rollbacks at the federal level would likely have a much bigger impact in other states. Fourteen states have total abortion bans, and several more like Florida and Georgia put caps based on a certain number of weeks.
Providers are also quick to emphasize that telehealth abortion, even if it remains widespread, could never completely replace in-person abortion care. The use of abortion pills is only common in the United States up to 12 weeks — after that, in-person procedures are the standard of care.
“Folks are showing us that they like in-person care, they like meeting with a clinician face-to-face and establishing a relationship,” Monast said.
Monast says she believes telehealth is working for a significant number of people, but providers still want to protect all forms of abortion access.
“But I don’t think that we should slide to the consideration that it would work for everybody,” she said.
Depending on how the Supreme Court rules in June, that increase in access could be unraveled. It worries Julia Kehoe, whose Health Imperatives clinics on the South Shore, Cape and Islands offer medication abortion.
“Working in Massachusetts, it’s the absolute best place to be doing this work,” Kehoe told GBH News, pointing to strong support from policymakers. “Having said that, we can’t lose sight of the fact that it’s a national picture that is so bleak.”
“Even when we’re a little bit optimistic about the mifepristone case or others, it’s very alarming because — one — you never know, and — two — there’s always another case coming down the road,” she added.
