The Challenges of Innovating Access to Abortion

The New Yorker March 7, 2019 (excerpts)

Telemedicine—obtaining medical services over the phone or through the Internet—is not a new phenomenon.

…Medical abortion (as distinct from surgical) relies on a drug protocol that was approved by the Food and Drug Administration in 2000.

What makes TelAbortion unique is the coupling of the two technologies. It enables a woman to terminate a pregnancy in the privacy of her own home, but with medical oversight.

The F.D.A. protocol, which involves two drugs—mifepristone and misoprostol—now accounts for thirty-one per cent of all non-hospital abortions in the United States…. When the two medications are taken together, they work between ninety-five and ninety-nine per cent of the time, depending on gestational age….

The TelAbortion service that ‘Kanu'uhiwa Thomas’ (a pseudonym) hoped to use is part of a five-state trial that the reproductive-health initiative Gynuity launched, in 2016, in response to the ever-diminishing availability of abortion services in the United States. As of the end of January, two hundred and eighty-three women had received TelAbortions, a hundred and fifty-eight of them in Hawaii.

Dr. Bliss Kaneshiro, an ob-gyn at the University of Hawaii, who is one of four physicians in her practice participating in the Gynuity trial … has done about eighty telemedical abortions….

Although the five states in the TelAbortion trial have some of the most accommodating abortion laws in the country, Gynuity is only able to run the trial with a waiver from the F.D.A….

In 2017, the American Civil Liberties Union sued the F.D.A. over the rems on behalf of the California Academy of Family Physicians; the Society of Family Planning; Pharmacists’ Planning Services, Inc.; and Dr. Graham Chelius, the chief of staff at Kauai Veterans Memorial Hospital, who is the named plaintiff….

Women who obtain and self-administer abortifacients outside the traditional medical establishment, typically from an Internet pharmacy, may be subject to arrest and imprisonment. In 2013, a woman in Pennsylvania who had ordered them online for her teen-age daughter was sentenced to a nine-to-eighteen-month jail term for “providing abortion without a medical license, dispensing drugs without being a pharmacist, assault and endangering the welfare of a child.” It is now possible to order these medications through Aid Access, a program overseen by a doctor in the Netherlands. So far, no one has been arrested…

As a resident of Hawaii, and as a participant in the Gynuity trial, Thomas was shielded from these dangers. After she was finally cleared to talk with Dr. Kaneshiro, Thomas sat outside, under a tree, during her lunch break, pulled out her smartphone, and spent about half an hour talking with the doctor. Soon afterward, the medications (and instructions) arrived in the mail. She would talk to Kaneshiro one more time, about a week after the abortion.

Thomas took the pills after she got home from work, the first one at 4:30 p.m., the second set at six, and, by eight, she was cramping. “I was just kind of watching TV and riding out the contractions,” which lasted for about six hours, she said. “I was exhausted, so, when it happened, it caught me so off-guard. The fetus was really small, but it was significant to me, so I cried. I just sat there, crying.”….

read … The Challenges of Innovating Access to Abortion