How Telemedicine Startups Are Revolutionizing Abortion Health Care in the U.S.[:]

26 November, 2020

11/16/2020 by CARRIE N. BAKER

Telemedicine abortion startups are springing up across the country after a federal court in July temporarily suspended Food and Drug Administration (FDA) restrictions on distribution of the abortion pill during the pandemic.

These new virtual clinics screen patients by video conference, telephone or text, using the new no-test, no-touch medical protocol that is now the standard of care for medication abortion (which uses pills to end a pregnancy). They then mail the medication to their patients at home, often using new online pharmacies. In total, people in 19 states and Washington D.C. now have legal access to telemedicine abortion from a doctor within their state.

These startups are revolutionizing abortion care by offering quick, private, safe, convenient and affordable services.

Approved by the FDA for use during the first 10 weeks of gestation, medication abortion uses two types of pills:

  • mifepristone, which interrupts the flow of the hormone progesterone that sustains the pregnancy; and
  • misoprostol, which causes contractions.

 

This combination of pills is 95 percent effective and is an extremely safe way to end a pregnancy. Many people choose telemedicine abortion because it is less invasive, more private and more convenient than in-clinic medication abortion or procedural abortion by aspiration. According to the Guttmacher Institute, medication abortion accounts for 60 percent of abortions performed up to 10 weeks gestation in 2017, having increased significantly in the last few years.

New Telemedicine Abortion Startups

The non-profit Just The Pill opened for business on October 12, offering telemedicine abortion care to people in Minnesota. Choix opened on October 28, offering abortion care to people aged sixteen and over in California.

Just the Pill and Choix are fully virtual abortion clinics. The non-profit carafem, which had previously offered in-person abortion care, now offers telemedicine abortion care to people living in Georgia, Illinois, Maryland, Washington, D.C. and Virginia. A new digital abortion provider, Hey Jane, will launch soon in California, New York and Washington.

At Just the Pill, patients fill out an online form and then have a follow-up phone call with a patient educator and a doctor, who then mails the pills to eligible patients. There are follow-up phone calls at seven days and four weeks. Just the Pill has a feminist fee structure, with a sliding scale from $0-$350 (they don’t take insurance). The difference is made up by the Minnesota abortion fund, Our Justice.

According to Medical Director Dr. Julie Amaon, Just the Pill formed to serve people in rural Minnesota who live far from the state’s five abortion clinics, which are concentrated in urban areas. Dr. Amaon told Ms. they have seen about thirty patients so far.

“Most of our patients live more than 100 miles from the nearest clinic,” says Dr. Amaon. “Ninety-seven percent of counties in Minnesota do not have an abortion provider. In our research, people are having to sometimes drive three or four hours for services. That’s tough when you have kids at home and you’re trying to look for childcare.”

“This is a very safe early option—that you can have a telemedicine appointment with a doctor in the comfort of your home and you get something mailed to your home. You don’t have to leave the house,” Dr. Amaon told Ms. “Women know how to take care of their bodies. This is just inducing a miscarriage. This is very safe. People have been doing this for centuries on their own. To have that ability to be able to take care of yourself at home, I think that’s just an amazing service. And it should continue to be an option for women.”

Just the Pill offers translation services and is now working to expand their services into Montana.

At Choix, patient care is conducted asynchronously by HIPPA compliant, encrypted texting. Patients fill out an online form and medical professionals consult with them by text, or telephone if desired, then mail the abortion pills if they are eligible. There are follow up check-ins 72 hours and one month after the abortion. Choix charges $199 (compared to $500 for in-clinic medication abortion in California). They do not take insurance at this point, but they work with the digital mutual-aid abortion fund, ReproCare, which supports a sliding scale payment mechanism right on the Choix website that ensures equity of access for all.

The co-founders of Choix, Cindy Adam and Lauren Dubey, told Ms. they had both worked as clinicians in a primary care practice, but they wanted to be able to provide a different type of care.

“We wanted to expand access to folks who have limited access,” said Adam, who is CEO at Choix. “We really wanted to help revolutionize abortion care. We are both really passionate about sexual reproductive health care.”

Normalizing Abortion Care

“The big push in the abortion world is to normalize abortion. Abortion is part of normal reproductive health,” says Dr. Aisha Wagner, the collaborating physician at Choix.  “This is something that I think we need to shout from the rooftops.”

“Abortion is a totally normal part of your reproductive health care. Having a pregnancy that you no longer want to continue is for some people, a very huge grave decision and for other people it’s not a big deal,” says Dubey, who is the Chief Nursing Officer at Choix. “People coming to our platform can come with pride or with shame—whatever their own feelings are, we will treat everybody with dignity and respect.  We want people to feel like we’re their partners in their reproductive future. We’re not here to judge them.”

Spreading the Word and Expanding Care

The organization Plan C, which advocates for expanded access to medication abortion, has just rolled out a comprehensive new website with information for medical professionals and patients.

The website includes all the new avenues for pill access that now exist in the US, including telemedicine services, online pharmacies, and reliable websites selling the abortion pill. Searchable by state, the website offers patients information about all of their options wherever they live, as well as information about financial support, legality, and legal resources. Plan C also offers a tool kit for medical professionals with a step-by-step guide on how to become a medication abortion provider.

In addition to the new start-ups, other avenues to access abortion pills include the TelAbortion research study and the overseas organization Aid Access.

Since 2016, Gynuity Health Projects has operated TelAbortion, which allows clinicians participating in the study to provide medication abortion care by videoconference and mail the abortion pill without an in-person visit to a clinic. The study is currently running in 13 states and DC: Colorado; Georgia; Hawaii; Illinois; Iowa; Maine; Maryland; Washington, D.C.; Minnesota; Montana; New Mexico; New York; Oregon and Washington.

From outside of the United States, the organization Aid Access has U.S.-based physicians providing telemedicine abortion service in New York, New Jersey, Washington, Nevada, Idaho and Alaska.

In states that do not yet have telemedicine abortion services, evidence indicates that people are obtaining the abortion pill by other means.

Aid Access serves people in all 50 states, offering online consultations and shipping of the abortion pill from abroad for a sliding scale fee as low as $95.

Others are ordering the abortion pill from websites and self-managing their abortions. Plan C has researched the quality and cost of the abortion pill sold on various websites, including the reliability, shipping time, and payment options for these websites. This information is available on the Plan C website, along with information about safe use of the abortion pill (also provided by SASS). The Reprocare Healthline offers medical information about the abortion pill and peer-based, trauma-informed emotional support seven days a week. Repro Legal Helpline answers questions about legal rights and self-managed abortion.

Finally, Wells says that research indicates that some people are using mail forwarding services such as iPostal1.com or Anytime Mailbox to rent an “address” in state that have legal online abortion services, then doing an online consultation at a digital abortion clinic and listing the forwarding service address as the shipping address.

According to the Plan C website,

“If asked, they confirm they are in that state at the time of the consultation (since the services are only allowed to serve people in those states)… When the mail forwarding service tells them that a package has arrived at their ‘address,’ they ask for it to be forwarded to them at their home address.”

The problem with this option is that it may jeopardize the health providers, who are only allowed to serve people within the states in which they are licensed.

Going Forward

Telemedicine abortion care is revolutionizing abortion health care by significantly expanding abortion access in the United States. The pandemic has opened a door that will hard to close back up. Once people realize how safe, easy, and accessible medication abortion can be, they are unlikely to go quietly back to the old days of cumbersome, over-medicalized, time-consuming and expensive abortion health care.

People creating new telemedicine startups repeatedly emphasize the need to increase access to abortion health care, especially for people living in rural areas or in places without abortion clinics.

“We’ve been trying to fight for a long time to say abortion should remain legal,” says Grant of carafem. “But it’s equally important in the places where it’s legal to make sure it’s accessible. Because if you can’t get to the care, whether it’s legal or not doesn’t really matter. So if you’re in a small town, and don’t have a car, and don’t have a job, and are stuck without anyone that’s going to be supportive of your decision, then you effectively still have no choice even though it is legal in your state.”

Source: https://msmagazine.com/2020/11/16/just-the-pill-choix-carafem-honeybee-health-how-telemedicine-startups-are-revolutionizing-abortion-health-care-in-the-u-s/ [:]

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