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At-Home Abortion Is No Magic Pill
Katie Glenn, J.D. | 28 May 2020
This article originally appeared online on the Washington Examiner Opinion Page (April 8, 2020). The article has been updated to reflect a more in-depth analysis of the situation regarding telemed abortions during the COVID-19 pandemic. You may view the original article here: https://www.washingtonexaminer.com/opinion/at-home-abortion-is-no-magic-pill.
In 2000, the federal Food and Drug Administration (FDA) approved the new drug application for Mifeprex,[i] a drug used to terminate an early pregnancy. However, it did so with restrictions, including that the pills be obtained in person directly from a clinician licensed to prescribe and administer drugs. Over the years, and with updated information, these regulations have changed slightly, but the core premises—appropriate timeframe, treatment, and administration—have stayed the same.
Two decades later, and with the backdrop of the COVID-19 pandemic, abortion activists have been pushing for a loosening up of chemical abortion regulations so they can send abortion pills through the mail using telemedicine. Planned Parenthood’s Acting CEO Alexis McGill-Johnson called it the “silver lining,” stating, “Planned Parenthood and many other health providers have actually been able to really lean into telehealth infrastructure and provide service.”[ii]
Unchallenged by the mainstream media,[iii] they claim that existing federal regulations are antiquated, and at-home abortions solve the problem of travel and using scarce resources like personal protective equipment (PPE). They propose a system where a woman would video chat with a doctor who would either mail the pills to her home or call them into a pharmacy or clinic where someone could pick them up.
Abortion activists now demand abortion without limitation, delay, or oversight. In fact, in the Democratic primary leading up to the 2020 election, Hawaii Congresswoman Tulsi Gabbard was the only candidate who voiced support[iv] for any abortion restriction whatsoever.
In reality, America’s current version of “telemed abortion” achieves none of their goals—except, of course, terminating a pregnancy—and only a regime that significantly increases the health risks to women would.
The "chemical abortion pill" is actually a regimen of two drugs, mifepristone, and misoprostol. In most states, a woman takes the first pill on-site and the second pill later at home. According to the world-renowned University of California, San Francisco Health Center, “a medical abortion involves at least two visits to a doctor's office or clinic.”[v]
In the telemedicine version, a woman goes to a clinic to obtain an ultrasound with a technician. There she consults with a physician via video chat. If she is determined to be a medically appropriate candidate for the drug, the doctor remotely unlocks a drawer and sees her take the pills from it.
One to three weeks after taking the pills, the woman returns to her provider for a follow-up visit. In fact, the Mayo Clinic states that: “Medical abortion isn't an option if you…can't make follow-up visits to your doctor or don't have access to emergency care.”[vi]
So, to recap, currently, a "telemed abortion" still involves at least two visits to a healthcare provider, whether that is the prescribing doctor or an ultrasound tech before the abortion and the doctor again for follow up care. Each visit requires travel from the woman's home to the clinic and the use of personal protective equipment.
If you ask these abortion advocates, the solution is to send the pills directly to the woman in the mail after video chatting with a doctor. The cost savings of travel and PPE become the woman’s health and safety. It takes a pretty shoddy doctor to run roughshod over federal regulations and send out pills without any confirmation of whether the recipient is a medically appropriate candidate for the drug or even whether that person is the one who takes it.
A number of factors determine whether a woman is medically eligible for chemical abortion: medical history, gestational age, and ruling out an ectopic pregnancy.
Chemical abortion is ineffective in terminating an ectopic pregnancy and cannot be used after the first 70 days of pregnancy due to heightened risk to the woman's health. Neither of these critical factors can be determined at home by the woman herself, which is why under current "telemed abortion" protocol, she still has an ultrasound prior to receiving the pills.
Even if she is a medical candidate for the abortion pill, the doctor must know that the woman is not being coerced by a partner, parent, or abuser. The doctor must also know that she is the one who will be taking the pills and that they are not being obtained for someone else.
This is why around 20 states require that the pills be supplied directly from the physician in the clinic. Traffickers and abusers love the idea of relaxing telemed abortion because it becomes easier to use chemical abortion to cover up their crimes. Remember that time a man ordered abortion pills online from India for a New York Times story?[vii]
It is impossible to reach the medical or social certainty needed to prescribe abortion pills through a video chat. Telemed abortion without limitation would increase the likelihood of coerced abortion or that the pills are taken by someone who is not medically eligible for the drug regimen and will suffer complications without a doctor’s supervision.
After a chemical abortion, a woman needs to visit a clinic for follow up care. The doctor must check that the pregnancy is fully terminated and assess whether the woman is suffering from any physical or psychological effects of the abortion and treat them.
This is especially important as most Americans self-quarantine, which can exacerbate anxiety and depression. Now more than ever, post-abortive women cannot be left to suffer alone.
Support for unrestricted at-home abortion is rooted in ideology, not medicine because even the current medically accepted version of "telemedicine abortion" very closely resembles the traditional process and requires at least two in-person appointments.
Ultimately, loosening up chemical abortion regulations and practices enriches unscrupulous doctors while endangering the physical and emotional health of women and girls.
While telemedicine has many beneficial applications, especially during the COVID-19 pandemic, abortion is not one of them.
[i] See https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information.
Katie Glenn, J.D., Government Affairs Counsel, Americans United for Life