Telemedicine has created an environment where patient convenience paired with reduced costs and increased efficiencies have made a better health care experience for both patients and physicians.
The technology might be able to improve rural health care systems by increasing access to patients who would otherwise have to travel long distances. Meaning those who would otherwise forego care due to difficulties with transportation, costs or time, could now receive care. For providers, telemedicine improves access to care by assisting in recruitment and retention of providers in rural areas.
Opportunities to expand women’s reproductive health care are vast with telemedicine. Increasing access to medical abortions through the use of telemedicine remains a huge untapped market for providing better access to early abortion care in rural areas of the United States, for example.
Telemedicine can be utilized to improve access to medical abortions by reducing the number of clinic visits and distance traveled for women seeking an abortion allowing women to go to their nearest clinic rather than to one that is currently staffed by an abortion provider. Often rural clinics are not consistently staffed by an abortion provider, as they may be traveling between clinics to provide services, thus, limiting their availability to a few days a week per clinic.
Physicians to reduce their travel time and increase their amount of available appointments, therefore, increasing access to medical abortions with the help of telemedicine.
Medical abortions work well in tandem with telemedicine because it does not require a physician-led procedure. Two-thirds of abortions in the U.S. occur at eight weeks of pregnancy or earlier — and this is within the nine-week gestational limit of medical abortions. Providing medical abortions via telemedicine has the same rate of success and as few adverse effects as in-person appointments for the same procedure. They also have high levels of patient satisfaction, possibly due to the convenience of obtaining services closer to home or by enabling women to have an earlier abortion.
There is not only a large and growing demand for medical abortions, but a unique opportunities to be combined with telemedicine in rural settings.
Despite all the benefits that tele-abortion gives patients, there have been policies and restrictions enacted in recent years that make providing abortion services through telemedicine increasingly tricky. Two laws, in particular, have circulated conservative in state legislatures that impact access to it.
Thirty-four states have passed a law that requires a medical abortion to be provided by a licensed physician. This law exacerbates the limited access to abortion by those in rural communities by limiting the number of health care providers who can give it. Nineteen states have passed a law that requires a physician’s physical presence when prescribing medical abortions. This law directly prevents the provision of a medical abortion through telemedicine. Both of these laws are enacted in areas where a woman already has to travel at least 30 miles to their nearest abortion clinic and in some cases as far as 180-plus miles.
Planned Parenthood of the Heartland has had a telemedicine program in Iowa that has been running for nearly ten years. Similar programs have been established in Alaska, Minnesota, and Maine. These programs show that telemedicine abortion can increase access to care in several places. A few health system changes can further improve that access to care in rural America. The first is allowing mid-level health care practitioners to provide medical abortion through telemedicine. They already provide care for many parts of the medical abortion visit, including reviewing health records, performing ultrasounds, options counseling and conducting the follow-up visit.
This concept has already been accepted in several states. In 2013, California passed legislation that allowed advanced practice nurses, nurse-midwives and physician-assistants to provide medical abortions. Twelve states have already adopted a similar law. By extending this policy to include telemedicine for medical abortions, the provider base would expand and allow greater access to early abortion care.
Opportunity to expand access to medical abortion services in rural communities by creating an expanding provider base of mid-level health care practitioners exist in at least 34 states that currently only allow licensed physicians to provide medical abortions. Other states have yet to pass legislation similar to California that explicitly allows mid-level health professionals to provide abortion care.
Removing the physical presence requirement of physicians is critical in the expansion of medical abortion through telemedicine. This increases access to medical abortions in rural America as women would be able to visit clinics closest to them rather than scheduling and traveling to farther clinics that have a physician on staff on a particular day. Telemedicine decreases logistical planning and costs for women.
By allowing health care providers to use telemedicine abortions, they can cover more appointment time slots and can increase the care that each clinic offers women. This, again, also reduces travel distance and logistics planning that women must consider when seeking a medical abortion.
There are currently opportunities in 19 states to ban telemedicine for medical abortion. Precedence has also been set to overturn this legislation. The Iowa Supreme Court struck down the restriction on the basis that it caused an undue burden to a woman’s right to access abortion services. Iowa’s Supreme Court used federal constitutional law set by the 1992 Planned Parenthood v. Casey Supreme Court decision. This precedent suggests that future challenges to telemedicine abortion bans could be successful and should be pursued in these 19 states.
By increasing access to early abortion through a medical abortion, the use of telemedicine improves the life course of women by allowing them to have children when desire and to avoid adverse effects of pregnancy if they decide that carrying a pregnancy to term is not currently the right choice for them. The two policy recommendations above should be adopted to increase access to medical abortion via telemedicine in rural America.
Elizabeth Ly is a public health student.
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