Abstract and Introduction
Objectives: To quantify the impact of telemedicine for medication abortion (TMAB) expansion or ban removal on abortion accessibility.
Methods: We included 1091 facilities from the 2018 Advancing New Standards in Reproductive Health facility database and Planned Parenthood Web site, among which 241 did not offer abortion as sites for TMAB expansion. Accessibility was defined as the proportion of reproductive-aged women living within a 30-, 60-, or 90-minute drive time from an abortion-providing facility. We calculated accessibility differences between 3 scenarios: (1) facilities offering abortion in 2018 (reference), (2) the reference scenario in addition to all facilities in states without TMAB bans (TMAB expansion), and (3) all facilities (TMAB ban removal). We also stratified by state and urban–rural status.
Results: In 2018, 65%, 81%, and 89% of women lived within a 30-, 60-, or 90-minute drive time from an abortion-providing facility, respectively. Expansion and ban removal expanded abortion accessibility relative to the current accessibility scenario (range: 1.25–5.66 percentage points). Women in rural blocks experienced greater increases in accessibility than those in urban blocks.
Conclusions: TMAB program and policy changes could expand abortion accessibility to an additional 3.5 million reproductive-aged women.
Public Health Implications: Our findings can inform where to invest resources to improve abortion accessibility.
Obtaining a wanted abortion is a determinant of psychological, physical, social, and economic well-being among US women and of social and economic well-being among their children.[1–9] (Not all individuals who seek abortion care identify as women. To date, much of the abortion literature has focused on the experience of "women." When citing past literature reported as including "women," we use that language. Similarly, the US census data we used included the population of US "women." When referring to people who received abortion care, we use the term "client.") Furthermore, abortion is legal, safe, and supported by major medical organizations.
However, many state-level restrictions on abortion access and provision create barriers to care.[11–19] Given these barriers, measuring access to abortion care in the United States is important for public health decision making. One component of access, accessibility (defined by Penchansky and Thomas as "the relationship between the location of supply and the location of clients"), (p128) is often operationalized as how far people are from health services, regardless of their immediate need for those services. Studies in the United States indicate that implementation of antiabortion policies can decrease abortion accessibility.[13,18]
In 2008, to overcome a state-imposed physician medication abortion dispensing regulation, Planned Parenthood of the Heartland in Iowa launched a site-to-site telemedicine for medication abortion (TMAB) care delivery model. Under this model, clients visit a health center where an abortion provider is not physically present and meet with a remote clinician via videoconference. As in an in-person medication abortion visit, the clinician answers the client's questions and may watch as the client is given the first dose of abortion medication. Relative to in-person medication abortion, TMAB is equally or more safe, effective, and acceptable to clients and providers.[21–23] Furthermore, in comparison with clients seen at this clinic network before TMAB implementation, those seen after implementation traveled slightly shorter distances.
Although Planned Parenthood has expanded use of TMAB since 2008 to additional states where the service is not banned, as of 2018 nearly half of Planned Parenthood health centers did not offer any abortion services. Furthermore, because of the politicization of abortion, use of telemedicine to deliver medication abortion, including via TMAB services, has been banned in 19 US states. We sought to expand on the existing literature by quantifying the potential impact of TMAB expansion, or removal of TMAB bans, on abortion accessibility among all US women of reproductive age.
Am J Public Health. 2022;112(8):1202-1211. © 2022 American Public Health Association