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Complicated legal landscape limits telemedicine abortion power 2022

Complicated legal landscape limits telemedicine abortion power 2022

in view of a The leaked Supreme Court draft opinion in Joe Roe v. Wade, many states in the US are set to further restrict access to abortion, with nearly half of the states making abortion illegal or heavily restricting it if Roe is reversed.

But the landscape for abortion access – and women’s health care in general – has changed a lot since the case was decided in 1973. Mifepristone, part of a two-pill course with misoprostol that can be used to terminate a pregnancy up to 10 weeks old, was approved by the FDA in 2000. According to the Guttmacher Institute, a reproductive health research institute that supports abortion rights, drug abortions made up 54% of US abortions in 2020, up from 37% in 2017.

meanwhile, The expansion of telehealth during the COVID-19 pandemic and the slow but steady growth of women-focused digital health startups have demonstrated other ways of delivering healthcare. But the abortion law and regulatory landscape is complicated, creating barriers for providers and companies that want to offer drug abortions through telehealth.

“So, there are telehealth laws, abortion laws and who can provide them,” said Lauren Dubey, chief nursing officer Choix, a telemedicine clinic that offers drug abortion as well as contraception. “So, it’s a bit of a regulatory nightmare.”

a complex landscape

many states There are already laws on the books to restrict access to drug abortions delivered via telemedicine. Tennessee Gov. Bill Lee recently signed a bill into law that would make abortion via telehealth a Class E felony, punishable with a fine of up to $50,000. This law will be effective from 2023.

In March, South Dakota Gov. Kristi Noem Signed a bill that would require women to make at least three separate trips to the clinic to get drug abortions, but that law has been halted by a court injunction.

Anti-abortion nonprofit Susan B. Marjorie Danenfelser, president of Anthony List, said: “The sustainable protections created today are critical to preventing the spread of dangerous mail-order abortion drugs, which put both unborn babies and their mothers at serious risk.” , said by statement regarding the law of South Dakota.

Although, Studies have shown that the outcomes of getting a drug abortion through telemedicine are similar to those of personalized care. A study of 110 patients published last year jama network open found that 95% had a complete miscarriage without any additional medical intervention, and no patients reported major adverse events. research published in British Journal of Obstetrics and Gynecology Patients using the telemedicine or hybrid model waited less time for treatment than referral, on average, and were provided with more abortions at less than six weeks’ gestation.

Physician-related restrictions are another obstacle. Thirty-two states require the physician administering drug abortion to be a physician.

“It allows a more efficient healthcare system to be able to hire that range of physicians. But even if you have the technical infrastructure to provide drug abortion, if you don’t have a provider So that’s going to be a stopgap,” said Liza Fuentes, a senior research scientist at the Guttmacher Institute.

While some states have increased restrictions, the FDA has loosened rules surrounding the abortion pill. In December, after temporarily lifting the in-person dispensing requirement during the COVID-19 pandemic, the FDA decided that patients could Receive mifepristone via mail permanently.

But it’s not clear how state law and federal regulation negotiate when it comes to drug abortion, said Laurie Sobel, associate director of women’s health policy at the Kaiser Family Foundation. In 2014, a federal judge in Massachusetts Repealed a state law that attempted to regulate opioids more strictly than the FDA, arguing that the Massachusetts order was pre-empted by federal law.

zenbiopro, which manufactures mifepristone, has already challenged Mississippi’s restrictions, arguing that federal rules supersede state law. No decision has been taken in that matter yet.

Sobel said: “It’s an interesting situation, in that it’s a drug, which is regulated at the federal level by the FDA. … If they say abortion is actually not constitutionally protected, and it’s in the states.” Goes back, and the states have to decide if they want to ban abortion or if they want to protect it or how they want to proceed, how does that regulate the drug with the FDA?”

Can telemedicine bridge the access gap?

Even though the law remains complicated for providers and patients seeking drug abortions via telehealth, there are ways it can improve access. For example, in states with some restrictions, it may be easier for a woman with childcare concerns or a woman who lives far from a clinic to have an abortion via telehealth.

And as states add restrictions, providers in surrounding states could be overwhelmed with people traveling for abortions, said Dubey of Choix.

“We see a lot of patients in Colorado who are saying, ‘Yeah, I tried to make an appointment at my local Planned Parenthood, but the wait is two and a half weeks, and then I’ll be too late for a drug abortion.’ And we know from our colleagues and from the general abortion scenario that telehealth can help,” she said.

but as In other telehealth processes, providers need to take into account who may be left behind, such as people who do not speak fluent English or who do not have access to high-speed Internet.

Kaori Suyoshi, director of innovation at Planned Parenthood, said it was a huge effort to build out telehealth services at the start of the COVID-19 pandemic. They set up teaching laboratories among their partners to share best practices regarding broadband access, language support and privacy. The reproductive healthcare provider also spent time training staff to assist patients and developing educational materials so patients could more easily log on.

“Telemedicine increases access to health services, [but] We’re still at a crisis point when it comes to abortion access in America,” she said. “And I think that’s clear. For anyone who is absolutely paying attention to the news, but attacks on abortion are on the rise and the abortion access landscape is in historical danger right now.”

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