Telehealth playing a key role in abortion access in the Dobbs era, expert says

In the Dobbs era, telehealth is playing a vital role in abortion access, particularly for people living in rural and underserved areas, Ushma Upadhyay, a professor of obstetrics, gynecology, and reproductive science at the University of California, San Francisco (UCSF), told Healthcare Brew.

The most recent report from the Society of Family Planning, a nonprofit that’s been tracking in-person and telehealth abortion data since the June 2022 Dobbs v. Jackson Women’s Health Organization ruling, found that about 19% of all abortions took place via telehealth from October to December 2023, translating to an average of 17,000 telehealth abortions per month in that period. Comparatively, telehealth abortions made up 16% of all abortions in September 2023.

A telehealth abortion involves a patient seeing a clinician via a remote consultation either over the phone, a video call, or messaging, and then receiving a medication abortion pill in the mail, according to the report released May 14.

The data also shows that shield laws—which allow providers in states without abortion bans or restrictions to legally provide telehealth abortion services to patients living in restricted or banned states—have helped people access abortion care, the report found. Between October and December 2023, an average of 5,800 telehealth abortions protected by shield laws took place per month for patients living in states with either six-week or total abortion bans.

Telehealth “has really done a lot to mitigate the losses to in-person abortion access,” according to Upadhyay, who also serves as co-chair of the society’s #WeCount initiative.

Upadhyay also said that telehealth abortions are particularly beneficial for people living in rural areas. In a UCSF study from 2023, vulnerable groups—including people who live more than 100 miles from the closest abortion clinic—were more likely to say that telehealth made accessing a timely abortion possible, she said.

However, telehealth abortions are not a complete fix to the lack of access in the Dobbs era, according to Upadhyay.

“My worry is that people will see the increasing numbers and think, ‘Oh, everyone living in those banned states are now getting telehealth abortions.’ That’s absolutely not true,” she said. “We can see that even if we add up all the shield law abortions—so the abortions provided under shield laws—it doesn’t come close to the number of abortions that were previously done in states [that currently have] abortion bans.”

For example, in Alabama, which enacted a total abortion ban immediately following the Dobbs decision, there were 6,489 abortions performed in the state in 2021. In 2022, that number fell to 3,777, a decrease of nearly 42%, according to data from the Alabama Department of Public Health.

Upadhyay said she’s concerned that patients who received a telehealth abortion and have follow-up questions in the weeks after the procedure won’t have access to in-person healthcare.

Patients of color have also been historically criminalized for accessing abortions, and therefore may be more hesitant to utilize telehealth abortions, Upadhyay added.

According to data from National Advocates for Pregnant Women and Fordham University, 59% of 368 pregnant women arrested between 1973 (when abortion was legalized) and 2005 were women of color.

Black and brown people are more likely to live in areas with abortion bans and restrictions—roughly 60% of Black women ages 18 to 49 live in states with abortion bans or restrictions compared to 53% of white women, according to KFF data.

“I just don’t want it to seem like [telehealth] is a solution for everybody,” she said. “People really do need care locally, within their communities.”

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