Telemedicine used to provide abortion medication in states where it is banned, study suggests
Provision of medication abortion under shield laws was strongly associated with structural barriers to in-clinic care, such as longer distance and higher poverty rates, data showed.
Online telemedicine is widely used to provide abortion medication in states with shield laws, an analysis found.
Researchers reviewed data collected from July 2023 to September 2024 by Aid Access, a nonprofit asynchronous telemedicine service that provides abortion medications to patients in every state and Washington, D.C. The nonprofit leverages shield laws, which allow U.S.-licensed clinicians to provide abortion medications to patients in states where it is banned while being protected from legal liability, and mails abortion medications to residents in 24 states with near-total or telemedicine bans on abortion. Findings were published in a research letter by JAMA on Aug. 11.
During the study period, Aid Access provided 118,338 medication abortion pill packs to residents of 2,649 U.S. counties, 99,293 (84%) of which were in states with near-total or telemedicine bans. Rates were higher in counties with more restrictive state policies, longer travel distances to clinics, greater poverty, and lower broadband access. After adjustment, rates were 3.12 times higher in states with near-total bans and 2.33 times higher in states with telemedicine bans compared with states where abortion is not banned.
Provision of abortion pills was also higher in counties 100 to 250 miles and more than 250 miles from a clinic compared with those within 50 miles of a clinic. Compared with counties with less than 5% poverty, counties with 5% to 9% poverty had 1.47 times higher provision rates, those with 10% to 20% poverty had 1.63 times higher provision rates, and those with higher than 20% poverty had 1.94 times higher provision rates. In addition, counties with 60% or higher broadband access had 19% higher provision rates.
Limitations include that the study relies on county-level rather than individual-level associations and that researchers did not assess completed abortions.
“Provision under shield laws is strongly associated with structural barriers to in-clinic care—but even in states where abortion is protected and shield law protections are not required, telemedicine usage remains associated with distance and cost barriers,” the authors wrote.
An accompanying editorial wrote that the current study presents “convincing data that telemedicine may be an increasingly used method of obtaining abortion care for low-income people living in rural areas of abortion-restrictive states.”
The editorialists also called attention to the myriad state laws physicians face if they consider offering telemedicine abortion care in restrictive states. “Although abortion care is a fundamental aspect of evidence-based reproductive medicine, the legal environment in the US after Dobbs contains more risks in providing the standard of medical care,” they concluded.