As we enter 2022, I am mentally and emotionally preparing myself for a future without federal abortion rights. The Supreme Court will likely decide on Mississippi’s abortion ban in June, with Dobbs v. Jackson Women’s Health Organization. If SCOTUS upholds Mississippi’s ban, it will result in a cascade of abortion bans across the country.
Our job between now and then is to help bolster the abortion infrastructure in Washington state that will allow residents and people from out of state to still find critical reproductive healthcare services.
The COVID-19 pandemic catalyzed adaptations in healthcare – like telemedicine and medication abortion – that may help us reach this goal, if they are continued. While these changes are not enough, they do make reproductive health care more accessible, especially for people coming from rural and lower income communities in Washington.
Increased access to telemedicine
Before the COVID-19 pandemic, research found that less than two percent of primary care visits were conducted virtually. By the end of 2020, this increased to nearly 20 percent.1 In addition, 58 percent of patients expressed comfort with virtual visits becoming the norm because they are more convenient, lower cost, and more accessible.2
Telemedicine offers an important way to reduce transportation and cost barriers to abortion access but does not fully eliminate these structural obstacles to seeking care.
The continued availability of telemedicine programs, however, will depend on whether and how COVID-19 emergency provisions are upheld. The federal COVID-19 Public Health Emergency (PHE) declaration, passed in 2020, has been extended in 90-day increments and was just extended again to mid-April 2022.3 Among other things, the federal PHE expands Medicare coverage for telemedicine beyond just rural patients. At the same time, many state PHEs require private insurers to cover virtual visits.4 In the early part of the pandemic, most states also relaxed their licensing rules to allow physicians to supply telemedicine from other states.5
Under the federal emergency provisions, Washington state expanded telemedicine options for providers, specifically under the Washington Volunteer Emergency Practitioner Act.6 This allows an out-of-state licensed practitioner to operate as if they have a Washington license, once they’ve been vetted by Washington’s system.7 More permanently, Washington passed Senate Bill 5385 in 2020, which requires reimbursement for telemedicine services at the same rate as in-person services. Then in July 2021, Washington House Bill 1196 took effect, which directs insurers to “provide the same coverage and reimbursement for audio-only telemedicine services as they would for care delivered in person or via audio-visual telemedicine.”8
Greater availability of medication abortion
Also, during the pandemic, the U.S. Food and Drug Administration (FDA) changed a long-time rule requiring health care providers to meet patients in person to prescribe the abortion pill, mifepristone.9 This change was made permanent in December 2020, allowing providers to continue prescribing mifepristone through telemedicine, which is a big step for expanding safe abortion care options.10
Research on the efficacy and safety of medication abortion shows that it is just as safe and effective as abortions provided in clinics.11 And studies have also confirmed that pregnant patients prefer telemedicine abortion because it is more private, convenient, and affordable.12 Self-managed abortions have become increasingly common in the U.S., already making up an estimated 39% of all abortions in 2019.13
Unfortunately, the FDA kept politically motivated restrictions that prevent mifepristone from being sold in pharmacies, despite it being safer than many other over-the-counter medications.14 It is also important to note that medication abortion is still only possible for patients who are no more than 10 weeks (about 2 and a half months) pregnant, and still requires progressive-leaning state legislatures to create the policy structures that allow access.15 So, while this is a promising expansion of care, it in no way ensures full reproductive freedom for all people.
How this has changed abortion access in Washington
In Washington state, our partners at Cedar River Clinics launched a telemedicine program for abortion care in 2020. Since then, they have seen a 79 percent increase in medication abortion and have reached more than 340 patients, half of whom live in rural parts of the state.16 They also tackled the challenge of limited internet access by opening a telemedicine satellite site in Yakima where people living in Eastern Washington can use the center’s technology to talk to providers in other parts of the state and can work with the staff to secure abortion medication and other resources.17
While the COVID-19 pandemic accelerated this program, it came from decades of work by abortion providers and activists who identified and looked for ways to overcome the most common barriers to access. Abortion infrastructure is multifaceted and takes years of important efforts across the reproductive freedom community.
What can you do about it?
While we all prepare for an era of limited abortion access in America, we must continue to advocate for policies in Washington state that protect and promote abortion care infrastructure and broader health equity.
Want to make sure that more people have access to safe, private, and affordable abortion care? Here is what you can do.
- Sign up for our 2022 Legislative Action Team to get alerts on how you can support passing critical bills this session that reduce abortion access barriers
- Donate to independent clinics like Cedar River Clinics