Good morning. Women in states with abortion bans are turning to telemedicine. |
 | | The misoprostol pill is used to terminate early pregnancies.George Frey/Reuters |
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Just two years ago, about 250,000 people had abortions in the U.S. states where the procedure is now banned or severely restricted, or probably soon will be. Since the Supreme Court overturned Roe v. Wade on June 24, allowing those prohibitions to take effect, where have women in these states turned? |
They're increasingly using telemedicine to get abortion pills. Because of access to the pills, a gray zone for providing abortions has emerged in the months since the court's decision. The method is safe and effective, though in states with bans, the delivery mechanism is not legal. |
Only one telemedicine service, Aid Access, openly provides pills in states with abortion bans. In the months preceding a leaked draft of the Supreme Court's decision, Aid Access received an average of about 83 requests a day from people seeking abortion pills in 30 states, new research found. In 27 of those states, abortion is now banned, likely to be banned or allowed only during the first six weeks of pregnancy. For comparison's sake, the study also included three states where the procedure is still widely available. |
Across the 30 states, requests to Aid Access for pills has risen to about 218 a day since the court released its decision at the end of June through September. The largest increases in queries came from states that enacted total abortion bans, as this chart shows: |
 | | Data is from Sept. 1, 2021 to June 23, 2022 and from June 24 to Sept. 30, 2022, before and after the Supreme Court overturned Roe v. Wade. | Source: Aid Access |
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This shift accompanies another one in how people get abortions. In states that have banned or restricted access, clinic-based procedures fell in July and August, according to other new research. As a result, women are carrying pregnancies they didn't plan or want. The increase in women seeking pills, however, mostly offset the drop, The Times reported. (Most, though not all, requests for pills to Aid Access end up being filled.) |
Clinics in states like Colorado, Illinois and New York have also seen more patients as women travel out of state for abortions. But the shift to telemedicine makes sense for practical reasons. First, having an abortion with pills at home, which has the physical effects of miscarrying, is as safe and effective in the first trimester as going to a clinic. |
Second, a quarter of women of childbearing age in the United States live — or will soon live — at least 200 miles from an abortion clinic. That distance is likely to pose an insurmountable obstacle for a significant number of people, especially those with low incomes. The telemedicine option is far cheaper than traveling. Aid Access asks patients for $105 to $150 and will accept less or nothing from people who can't afford to pay. By contrast, a trip out of state for an abortion often takes a few days and can run to $1,500 or more. |
It's also notable that abortion by telemedicine has risen in states that have not restricted abortion access, suggesting that more women are choosing it for "comfort and privacy" as well as necessity, said Abigail Aiken, a public health researcher at the University of Texas at Austin and a co-author of the study of the Aid Access data. |
Providing abortion pills via telemedicine, across state lines, raises legal questions. The Dutch physician Dr. Rebecca Gomperts, the founder of Aid Access, writes prescriptions for abortion pills for women in red states, using her Austrian medical license. I wrote a cover story for The New York Times Magazine last month about the efforts of American doctors and midwives to work with Gomperts. "I just want to scream, 'This is a public health emergency!'" one of the doctors, Linda Prine, texted me while I was reporting. Abortion opponents, on the other hand, say their state laws should bind out-of-state providers. |
Doctors like Prine, who is 71 and lives in New York, want their home states to shield them from out-of-state prosecutions, lawsuits and threats to their medical licenses. So far, several blue states have passed laws that seek to shield providers who perform abortions for women who travel from states with bans. Over the summer, Massachusetts went a step further, passing a law that aims to shield its providers when they offer telemedicine abortions to people within red states. |
A basic premise of the federalist system in the U.S. is that states help enforce each other's laws. Whether blue states can refuse to do so, on behalf of abortion providers, is an open question. |
The answer depends on politics as well as law. Republicans have expected to pay a price for the end of Roe in Tuesday's midterm elections. If they perform better than expected, legislators and prosecutors in red states may be more likely to aggressively pursue doctors like Prine if they follow through on defying the state abortion bans. They could also try to punish women who receive abortions via telemedicine, though abortion opponents currently say that's not their plan. |
Aiken's study suggests that the end of Roe may not have yet succeeded in reducing abortion as much as its proponents hoped. Women are proving resourceful in avoiding states' restrictions. But the real test is probably yet to come. |
- Democrats are worried their party has focused too much on abortion access as a midterm election issue and not enough on the cost of living.
- J.D. Vance, the Republican Senate nominee in Ohio, and Representative Tim Ryan, his Democratic opponent, sparred over abortion in a town hall event.
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 | | Representative Liz Cheney campaigns for Representative Elissa Slotkin in Michigan.Jeff Kowalsky/Agence France-Presse — Getty Images |
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Matthew Cullen, Lauren Hard, Lauren Jackson, Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Ashley Wu contributed to The Morning. You can reach the team at themorning@nytimes.com. |
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