The complex legal landscape limits the power of telemedicine abortion

Following A. Leakage of the draft conclusion of the Supreme Court which will prevent Ron vs. Wade, the availability of abortions will be restricted in many US states in the future. About half of the United States Abortion is likely to be illegal or severely restricted if Roe turns around.

But the landscape of access to abortion, and women’s health in general, has changed dramatically since the 1973 decision. Mifepristone, part of a course of two pills with misoprostol, can be used to terminate a pregnancy up to 10 weeks. Approved by the FDA in 2000 According to the Guttmacher InstituteThe Institute for Reproductive Health Research, which supports abortion rights, said that medical abortion accounted for 54% of abortions in the United States in 2020, up from 37% in 2017.

Meanwhile, that: Expanding health care COVID-19 epidemic և: slow but steady growth Women-focused digital health startups have shown other ways to deliver healthcare. However, the landscape governing abortion laws is complex, creating barriers for providers and companies seeking to offer medical abortions through telemedicine.

“So there are remote health laws, abortion laws, who can provide them,” said Lauren Dubay, director general of nursing. Choice:, a telemedicine clinic that offers medical abortion as well as contraception. “So it’s a bit of a regulating nightmare.”

Complex landscape

Many states There are already laws on books that will restrict access to abortion medicine through telemedicine. Tennessee Governor Bill Lee recently signed the bill which would make abortion through telecommunications an E-type crime punishable by a fine of up to $ 50,000. It is the law Intended to enter into force 2023

Martin Governor of South Dakota. Christy Noem signed a bill It will take women at least three separate visits to the clinic for a medical abortion, but the law is followed. Judicial act.

“Permanent protection today is vital to stop the delivery of dangerous abortion drugs by mail, which puts both unborn children and their mothers at serious risk,” said Marjorie Dannenfelser, Susan B. , says the statement on South Dakota law.

Nevertheless, studies have shown telemedicine delivery of abortion medicine Comparable results with personal care. a A study of 110 patients published last year in: JAMA network open It turned out that 95% had a complete abortion without any additional medical intervention, and no patient reported any serious adverse events. The study is published British Journal of Obstetrics and Gynecology It was found that patients waited on average less time from referral to treatment using the telemedicine or hybrid model, and more abortions were performed in less than six weeks of gestation.

Restrictions on doctors are another obstacle. Thirty-two states Require a doctor who performs medical abortions to be a doctor.

“It allows a more efficient health care system to be able to hire that circle of clinicians to be able to do that. “But even if you have the technology to provide a medical abortion, if you do not have a supplier, it will be a stop,” said Lisa Fuentes, a senior fellow at the Gutmacher Institute.

While some states have increased restrictions, the FDA has eased regulations on abortion pills. In December, after temporarily eliminating the individual provision requirement during the COVID-19 epidemic, the FDA decided that patients could: always receive mifepristone by mail.

But it’s unclear how state law ային federal regulation will interact when it comes to medical abortion, says Lori Sobel, Kaiser Family Foundation’s deputy director of women’s health policy. In 2014, he was a federal judge in Massachusetts failed state law which tried to regulate opioids more strictly than the FDA, claiming that the Massachusetts order was predetermined by federal law.

GenBioPro:The Mifepristone company has already challenged the Mississippi restrictions, arguing that federal law replaces state law. There is no verdict in that case yet.

“This is an interesting situation when it’s a drug that is regulated at the federal level by the FDA. If they say abortion is not constitutionally protected, it goes back to the states. ban abortion, whether they want to protect it or how they want to proceed, as it intersects with the FDA, which regulates the drug.

Can telemedicine bridge the gap?

Even if the law remains difficult for providers և patients seeking medical abortion through telemedicine, there are ways it can improve accessibility. For example, in states with fewer restrictions, it may be easier for a woman with child care problems or a woman living away from the clinic to have an abortion remotely.

And as states increase restrictions, suppliers in nearby states may be overwhelmed by people traveling for abortions, Choix’s Dubey said.

“We see a lot of patients in Colorado who say, “Yes, I tried to meet at my local Planned Parenthood, but the wait is two and a half weeks. I’m too late. medical abortion. “And we know from our partners in the general abortion landscape that distance health can help,” she said.

But like that other remote health proceduresProviders should pay attention to who may be lagging behind, such as people who do not speak fluent English or do not have access to high-speed internet.

It was a huge effort to create telemedicine services at the beginning of the COVID-19 epidemic, says Kaori Sueyoshi, Planned Parenthood’s director of innovation. They set up training labs in their branches to share best practices on broadband access, language support and privacy. The Reproductive Health Service Provider also took the time to train staff to help patients և develop training materials to make it easier for patients to access.

“Telemedicine increases access to health services, [but] “We are still at a critical juncture when it comes to access to abortion in the United States,” she said. “And I think it is obvious. “Anyone who pays attention to the news at all, but the attacks on abortion are on the rise, the landscape of access to abortion is under historical threat right now.”

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