The Revolution of Telehealth Services During a Global Pandemic

Story by Cynthia Maduka, Communications Intern (Summer 2020)

With the COVID-19 pandemic raging across the country, limited access to clinics, and bans on abortion access, technology has become an increasingly crucial tool for delivering safe and efficient reproductive healthcare. Almost overnight, online healthcare companies have revolutionized the way people are able to get access to these essential services, all from the comfort of the patients’ homes. Despite political barriers to abortion access, in some states this advent of widespread telemedicine offerings has included abortion care.

Even before the pandemic, Plan C had already been re-imagining how women gain access to abortion medication. Established in 2015, Plan C provides a platform that directs people to credible resources and information on obtaining cost-efficient abortion pills for those seeking self-managed abortion.

On their site, Plan C provides a research-based report card which contains information on various companies that provide abortion medication, services, and information. Each company listed on the report has a brief review which includes an assessment of pros and cons, and is given a letter grade based on factors such as states available, pricing, physician support and more. Currently Aid Access has the highest grade.

Plan C staff gather at a planning meeting, as seen in a New York Times piece highlighting the organization. Photo credit: Tracy Droz Tragos.

“Our work aims to provide the most robust, most informed and most useful website possible that has a page for people needing pills for self-managed abortion,” said Amy Merrill, the Digital Director at Plan C. “The guide to pills lays out some of the options and information about medication abortion, in order to help someone know if it’s the right method for them.”

While there is still stigma surrounding abortion, in the U.S, self-managed abortions have become the norm. A study conducted by the American Journal of Public Health in 2017-18 analyzed inquiries from 6,022 people through a telemedicine service called “Women on Web”. The study found that 60% of people requesting medication abortion were from conservative and liberal states alike, and turned to self-managed tele-abortion medication services as a personal choice or due to existing obstacles with accessing more traditional options. This demonstrates the growing interest in these services, and under COVID-19 this has become an even more direct need.

“Even pre-COVID there were barriers related to travel, barriers relating to waiting periods that required many people to wait several days after a consultation with the doctor, and there were barriers related to cost,” said Victoria Nicols, an advisor for Plan C. “Aid Access and other organizations that are providing abortion pills, by mail, tend to charge significantly less for their services and therefore reduce barriers related to travel and cost.”

Currently access to reproductive care has become limited – according to Nichols, 90% of US counties do not have an abortion clinic or provider, a number which has become even higher under the pandemic, and makes increased access to telemedicine ever more pertinent.

Whether everyday life is bustling or at a standstill due to a global pandemic, services like Plan C can direct women to services that offer no-contact abortion with abortion pills and ensure that these women have affordable access to reproductive health sources. While Plan C does not provide telemedicine services directly, they provide the information on how to obtain the services through their partners.

According to Nichols, they strategically position themselves as a catalyst, sharing information on partners and leading research on available sources of pills, pushing against illegitimate policy that is not evidence based and leveraging proving the safety and efficacy in data on safety and efficacy, in order to normalize and destigmatize this method for better access.

"I think COVID is challenging the status quo of what can be done."

Self-managed abortion is the process of terminating a pregnancy outside of a traditional clinic setting, usually with pills. Mifepristone (mifeprex) and misoprostol (Cytotec) are the two pills needed for a medicated abortion. Both pills were approved by the FDA back in 2000. Since then, it has been heavily regulated in some states, although research shows they are relatively safe.

“Under COVID-19, doctors are recognizing this opportunity to serve [patients] by mailing them pills, which was not done before,” said Merrill. “Now they are looking at the situation and realizing [that] under the pandemic, harm reduction means you wouldn’t ask a patient to come in. And when looking at the data, recognizing it’s safe and reasonable to allow people to self-manage.”

A 2017 study conducted by the Guttmacher Institute found that the “339,640 medication abortions provided by abortion facilities and other providers made up 39% of all abortions that year.” The 2017 US data also showed that “18% of non-clinical facilities reported meeting with patients who had attempted to self-manage their abortion, an increase from 12% in 2014.”    

“This current situation is opening everyone’s eyes to the myth that abortion pills can only take place in clinics. For years we’ve gotten push back with statements [along the lines of]: ‘it’s not safe for this to happen outside the clinic’ or ‘it’s not what people want’ or ‘it’s not what the medical system is set up for’. I think COVID is challenging the status quo of what can be done,” said Nichols.

While the pandemic has proven difficult to manage for many traditional forms of care, it has served as an accelerator for non-profits like Plan C that have an eye on the future. Their vision that healthcare is moving into a more online, privacy-focused, and self-managed space has placed them in a position where they can help a tremendous amount of people through an increasingly challenging year. You can learn more about the organization and the depth of research and information they have to share on abortion pills at their website.