Abortion rights in the United States have never seemed more under threat than they were this year. In September, the United States Supreme Court refused to block Texas’s Senate Bill 8—which effectively bans abortions after six weeks in Texas with very few exceptions. In December, the Supreme Court will hear arguments on Dobbs v. Jackson Women’s Health Organization, a case that will examine a Mississippi law that outlaws abortions after 15 weeks (almost two months earlier than is allowed under Roe v. Wade). But, against the backdrop of troubling court cases, there’s are encouraging developments afoot: Telehealth startups are making medication abortions—carried out by taking a combination of mifepristone and misoprostol—more accessible. Even as abortion-rights advocates await upcoming decisions by the courts and other regulating bodies with bated breath, the stage is set for increased access in 2022 and beyond.
“Ironically, what's happening in Texas has helped boost the visibility of modern medical options for abortion, including telehealth,” says Elisa Wells, MPH, a Wellness Trends Advisor and co-founder of Plan C, an organization that provides information on how people in the U.S. are accessing abortion pills online. “Traffic to our site just went up exponentially after September 1. And we also have heard from telehealth startups that their traffic [and] their requests for help [accessing abortion care] have gone up.”
FemTech Focus, a nonprofit organization dedicated to increasing awareness of and funding for the femtech industry, projects that by 2027, the abortion technology market will bring in around $3 billion. Telehealth abortion startups offering easier-to-access medication abortions will undoubtedly be part of that market growth; however, medication abortion isn’t new. The “abortion pill” has been available in the United States since 2000, and its median cost is $205, which is half the price of the average procedural abortion, according to data from the Kaiser Family Foundation. Medication abortions make pregnancy termination more convenient and infinitely more accessible—which is threatening to anti-abortion proponents.
Despite significant research on their safety, medication abortions are subject to the same regulations as in-office procedural abortions, even though there’s no surgical intervention involved: Before the COVID-19 pandemic, United States Food and Drug Administration (FDA) regulations required that patients have an in-person provider visit to get abortion medications, and the pills are not available at local retail pharmacies. Rules like these aren’t uncommon—medications like opioids, insulin, and cancer treatment drugs have Regulatory Evaluation and Mitigation Strategy (REMS) programs that are meant to protect patients, says Lauren Dubey, FNP, chief nursing officer and co-founder of Choix, a telehealth clinic offering abortion care and reproductive support. However, she argues that the risk of misuse is low with abortion medication. “The reality is that the REMS for mifepristone [are] completely politically motivated,” she says.
In July 2020, the FDA temporarily suspended the in-person requirement for receiving medication abortion, which meant patients could receive abortion pills via telehealth services. This loosening of telehealth restrictions catalyzed the launch of abortion startups with virtual clinics where patients can receive mifepristone (misoprostol isn’t subject to the same FDA regulations) in the mail with provider approval, says Leah Coplon, CNM, MPH, director of clinical operations at Abortion on Demand.
In July 2020, the FDA temporarily suspended the in-person requirement for receiving medication abortion, which meant patients could receive abortion pills via telehealth services.
Choix and Just the Pill lead the charge with 2020 launches; Abortion on Demand, now the nation’s largest abortion telehealth provider, operating in 20 states, followed in 2021. In July 2021, HeyJane, a telehealth abortion provider that launched this year and currently operates in New York, California, and Washington, D.C., raised $2.2 million in funding and is planning to expand into 19 states. “We are really encouraged not only by the investment [from] private sector endeavors but also the fact that people are stepping up,” Wells says, referring to the influx of individual donations being made to abortion funds and brick-and-mortar abortion clinics.
How much growth can we expect for abortion startups in 2022? Current local laws support telehealth abortion providers in 32 states, according to the Guttmacher Institute. However, loopholes for obtaining medication abortions do exist. In November, an online abortion provider called AidAccess began mailing abortion pills from overseas to all 50 U.S. states through a legal concept called advance provision, which allows the company to provide medication to people before they need it (kind of like keeping an EpiPen on hand). Though ordering medication from overseas is a bit of a legal gray area, advance provision might serve as a model for other providers. To that end, the most significant change for online medication abortion providers over the next year involves “expanding [services] to those other states and expanding partnerships locally,” says Cindy Adam, a family nurse practitioner and co-founder of Choix.
Another key piece to the puzzle: In May, the FDA began reviewing scientific evidence to assess whether REMs are necessary for mifepristone and will make a decision by December 16. “We‘re hopeful,” says Dubey. “Despite the fact that nothing is nonpartisan anymore, [the FDA is] really trying to look at the scientific data surrounding this medication, and it's promising.” This change would set us up to experience a country where medication abortions are far more accessible in 2022 and beyond.
Abortion rights activists have been working tirelessly to increase access and will continue to do so, with most deeply committed to increasing telecare and brick-and-mortar access in states where abortion laws are more restrictive.
“A lot depends on what happens with the Food and Drug Administration, which is currently reviewing the REMS restrictions,” Wells says. “Ideally they would go away, so that the pills would be available through normal distribution mechanisms, through pharmacies, and through online pharmacies, as almost every single other drug that people use is in the United States.”
Regardless of the FDA outcome, abortion rights activists have been working tirelessly to increase access and will continue to do so, with most deeply committed to increasing telecare and brick-and-mortar access in states where abortion laws are more restrictive, Coplon says.
“The reality is, systemic barriers to abortion existed long before the pandemic and will continue to exist long after,” says Danika Severino Wynn, CNM, vice president of abortion access at Planned Parenthood Federation of America. “We’re hopeful that the FDA will acknowledge the evidence and permanently remove the medically unnecessary barriers to medication abortion so that patients can more easily access the essential health care they need—during the pandemic and beyond.”
THE EXPERTS TAKE
"Attacks on medication abortion are not rooted in science. They are part of a larger agenda to control someone’s body and future. As these coordinated attacks — including the more than 100 abortion restrictions enacted into law in 2021 this year alone — continue, we must lean into listening to the science to increase access to safe and legal abortion for all."
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