Complex legal landscape telemedicine limits the power of abortion

In terms of a Leaked Supreme Court draft opinion that would overturn Rowe v. Wade, further restricting access to abortion in many U.S. states Nearly half of the states would probably outlaw abortion or severely restrict it if Rowe was overturned.

But the landscape of abortion access – and women’s healthcare, in general – has changed dramatically since the case was decided in 1973. Mifepristone, part of a two-pill course with misoprostol that can be used to stop pregnancy up to 10 weeks. Approved by the FDA in 2000. According to the Gutmachar Institute, a reproductive health research organization that supports abortion rights, drug abortions accounted for 54% of U.S. abortions in 2020, up from 37% in 2017.

Meanwhile, the The expansion of telehealth during the COVID-19 epidemic and the slow, but steady growth of women-centric digital health startups have demonstrated other ways to provide healthcare. But abortion laws and regulatory landscapes are complex, creating barriers for suppliers and companies that want to offer drug abortions through telehealth.

“So, there are telehealth laws, abortion laws and who can afford them,” said Lauren Dubey, chief nursing officer. Choix, a telemedicine clinic that offers contraceptives as well as contraceptives. “So, this is a bit of a regulatory nightmare.”

A complex landscape

Many states There are already laws in books to limit abortion access to drugs supplied through telemedicine. Tennessee Governor Bill Lee recently signed into law a bill that makes abortion through telehealth a Class E offense punishable by a fine of up to $ 50,000. The law is expected to take effect in 2023.

In March, the South Dakota Govt. Christy Neim Has signed a bill requiring women to make at least three separate trips to a clinic for drug abortions, but that law remains in force by court order.

“Permanent protections enacted today are vital to stopping the spread of dangerous mail-order abortion drugs, which pose a serious risk to both unborn children and their mothers,” said Marjorie Danenfelser, president of Susan B. Anthony List, an anti-abortion nonprofit organization called South Said by statement.

However, Studies have shown that abortion with telemedicine has comparable results with personal care. A study on 110 patients published last year Clothing network open 95% of abortions were performed without any additional medical intervention, and no patients reported major adverse events. The study has been published British Journal of Obstetrics and Gynecology Patients, on average, waited less time for treatment from referrals using telemedicine or hybrid models, and more abortions were performed at less than six weeks of gestation.

Physician-related restrictions are another hurdle. In thirty-two states, the physician conducting a medical abortion must be a physician.

“This allows for a more efficient healthcare system to be able to hire the range of physicians it can. But even if you have the technology to deliver abortion drugs, if you don’t have a supplier, it’s going to be a stopgap.” Scientist Lisa Fuentes says.

Although some states have increased restrictions, the FDA has relaxed the rules surrounding the abortion pill. In December, after the COVID-19 epidemic was temporarily lifted out of private distribution, the FDA decided that patients Get Mifepristone by mail permanently.

But Laurie Sobel, associate director of women’s health policy at the Kaiser Family Foundation, said it was unclear how the interaction between state law and federal regulations on drug abortion would work. In 2014, a federal judge in Massachusetts With the repeal of a state law seeking to regulate opioids more strictly than the FDA, the Massachusetts order was pre-empted by federal law.

GenBioPro, Which makes Mifepristone, has already challenged Mississippi’s restrictions, arguing that federal regulations exceed state laws. No verdict has been handed down in that case yet.

Sobel says: “This is an interesting situation, where it is a drug that is regulated by the FDA at the federal level…. Do they want to do it or do they want to protect it or how do they want to move forward, how does it intersect with the drug-regulating FDA? “

Can telemedicine fill the gap of access?

While the law remains complex for suppliers and patients for abortion through telehealth, there are ways it can improve access. For example, in states with some restrictions, telehealth abortions may be easier for women with childcare concerns or for those who are away from the clinic.

And with states adding restrictions, providers in nearby states may be overwhelmed by people traveling for abortions, Choix’s Dubey says.

“We see a lot of patients in Colorado who say, ‘Yeah, I tried to make an appointment at my locally planned guardianship, but the wait is over two and a half weeks, and then I’m going to be too late. Medication abortion.’ And we know from our colleagues and from the general abortion landscape that telehealth can help, “he said.

But like In other telehealth practices, providers need to pay attention to who may be left behind, such as those who cannot speak English fluently or those who do not use high-speed internet.

Kaori Suyeoshi, director of innovation at Planned Parenthood, said it was a huge effort to build telehealth services at the start of the COVID-19 epidemic. They set up learning labs across their affiliates to share best practices on broadband access, language support and privacy. Reproductive health care providers spend time training staff and creating educational materials to assist patients so that patients can log in more easily.

“Telemedicine enhances access to healthcare services, [but] We’re still in a crisis of access to abortion in the United States, “she said.” And I think that’s obvious. Everyone is paying attention to this news, but the attacks on abortion are on the rise and the landscape of abortion access is under threat at a historic level right now. “

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