Written by Anna Fiastro and Emily Godfrey

Due in part to increasing abortion bans, pregnancy-related deaths have significantly increased in the U.S. recently.^1,2 As a result, the life-saving potential and widely needed provision of medication abortion through telehealth has never been greater. Telehealth medication abortion (teleMAB) consists of a telehealth consultation – either a synchronous meeting by phone or video or an asynchronous conversation via text or email – followed by a prescription of abortion pills without requiring a clinic visit.³ TeleMAB can reach more geographically diverse patient populations – saving time and resources for in-clinic care.⁴ TeleMAB allows a single primary care clinician to serve not only their own clinic patients, but patients throughout an entire state, and even patients in other states where licensed.⁵ In states where abortion is banned or restricted, teleMAB options can be available, but the legal risks for patients and providers are great. Other teleMAB advantages include:

• Efficiency, with telehealth appointments taking less time for clinicians and staff.³
• Reduced delays in care, as those who receive care via telehealth are seen sooner and at earlier gestational ages compared to patients seen in the clinic.⁶
• Supporting patients in exercising control, autonomy, and flexibility.⁷
• Improving patient-centered communication, with patients being able to choose the setting where they have their consultation.⁸

TeleMAB fits within the scope of primary care practice. It is feasible to implement, especially if the primary care clinic is already providing telehealth for other medical issues and has a clinic champion who spearheads the effort.⁴ With a history screening tool, primary care clinicians can safely provide MAB via telehealth without the need for patients to undergo clinical laboratory or ultrasound tests.⁹ Once implemented, teleMAB fits well into the clinic workflow. Primary care practices using face-to-face synchronous video visits require 10-30 min of clinician time, and asynchronous email exchanges take only 2-5 minutes.3 U.S. FDA, regulations make it possible for primary care clinicians to mail mifepristone directly to patients or prescribe it through mail-order and/or retail pharmacies (Update: FDA’s Decision on Mifepristone REMS, Update on the Status of Medication Abortion and the Courts).^10-12 Alternatively, in clinics where mifepristone is unavailable, teleMAB using misoprostol only is an acceptable option. Learn more about how to implement teleMAB in the Access, Delivered Provider Toolkit.⁴

RHAP Resources:

How To Order Mifepristone

How To Use Abortion Pills Fact Sheet

Telehealth Care for Medication Abortion Protocol

How To Use Misoprostol-Only for a Medication Abortion

Insights: Medication Abortion Without Ultrasound: A Safe and Approachable Framework to Support the Expansion of Access

Insights: Misoprostol-only Medication Abortion

Insights: Updates in Rh Testing

Partner Resources:

Access, Delivered Provider Toolkit

RHITES

Birth Control Pharmacist

Abortion Coalition for Telemedicine (ACT)

1. Hoyert DL. Maternal mortality rates in the United States, 2021. NCHS Health E-Stats. March 2023. doi:10.15620/cdc:1246782. Stevenson, A. J. (2021). “The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant.” Demography 58(6): 2019-2028.

3. Fiastro AE, Sanan S, Jacob-Files E, et al. Remote Delivery in Reproductive Health Care: Operation of Direct-to-Patient Telehealth Medication Abortion Services in Diverse Settings. Ann Fam Med. 2022;20(4):336-342. doi:10.1370/afm.2821

4. Godfrey EM, Fiastro AE, Jacob-Files EA, et al. Factors associated with successful implementation of telehealth abortion in 4 United States clinical practice settings. Contraception. 2021;104(1):82-91. doi:10.1016/j.contraception.2021.04.021

5. Godfrey EM, Thayer EK, Fiastro AE, Aiken ARA, Gomperts R. Family medicine provision of online medication abortion in three US states during COVID-19. Contraception. 2021;0(0). doi:10.1016/j.contraception.2021.04.026

6. Srinivasulu S, Nyandak D,  Fiastro A, Tressan A, MacNaughton H, Godfrey E. “I’m doing this in my own time, my own energy, in my own home: patients experiences with telehealth abortion in primary care” Oral presentation at American Public Health Association, 2022

7. Silpa Srinivasulu, Deyang Nyandak, Anna Fiastro, Honor Macnaughton, Amy Tressan, Emily Godfrey. P052 “I feel like i had the best team”: Patients’ experiences with telehealth abortion in primary care. Contraception. 2022;116(85).

8. Godfrey EM, Fiastro AE, Ruben MR, Young EV, Bennett IM, Jacob-Files E. Patient perspectives regarding clinician communication during telemedicine compared with in-clinic abortion. Obstet Gynecol Jun 2023;141(6). DOI: 10.1097/AOG.0000000000005192

9. Raymond E, Grossman D, Mark A, et al. Medication Abortion: A Sample Protocol for Increasing Access During a Pandemic and Beyond. UC Davis. Published online April 8, 2020. https://escholarship.org/uc/item/02v2t0n9

10. American College of Obstetricians and Gynecologists. ACOG Statement on Court’s Order Lifting Burdensome FDA Restriction. American College of Obstetricians and Gynecologists. Published July 13, 2020. https://www.acog.org/en/News/News Releases/2020/07/ACOG-Statement-on-Courts-Order-Lifting-Burdensome-FDA-Restriction

11. Warren, Murray, Baldwin Urge FDA to Improve Access to Medication Abortion Drug Mifepristone Amid COVID-19 Pandemic | U.S. Senator Elizabeth Warren of Massachusetts. Accessed December 17, 2020. https://www.warren.senate.gov/oversight/letters/warren-murray-baldwin-urge-fda-to-improve-access-to-medication-abortion-drug-mifepristone-amid-covid-19-pandemic

12. Attorney General Becerra Leads Coalition of 21 Attorneys General Asking FDA to Increase Access to Reproductive Telehealth Care During COVID-19 Pandemic. State of California – Department of Justice – Office of the Attorney General. Published March 30, 2020. Accessed December 17, 2020. https://oag.ca.gov/news/press-releases/attorney-general-becerra-leads-coalition-21-attorneys-general-asking-fda

Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.

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