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Taking abortion pills at home helps reduce stigma associated with pregnancy termination, according to recent findings.
“It’s intuitive to understand that people are afraid of protesters outside of abortion clinics. But I was surprised that some people would be afraid to be perceived as abortion patients,” said Andréa Becker, co-author of the study, a reproductive health researcher and a sociology professor at Hunter College in New York City.
Becker and other researchers affiliated with the Advancing New Standards in Reproductive Health program at the University of California, San Francisco, spoke with 30 abortion patients who had telehealth medication abortions between May 2021 and January 2022, when Americans still had the federal right to an abortion.
Medication abortions — legal up to 70 days or 10 weeks gestation — have increased rapidly in the U.S. The method accounted for 53% of all abortions by 2020, and that number increased to 63% by 2023, according to Guttmacher Institute.
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The coronavirus pandemic, coupled with the U.S. Supreme Court’s decision to overturn Roe v. Wade in June 2022, increased the availability of abortions through telehealth in some states.
As of June 2024, telehealth medication abortions were 20% of all clinician-provided abortions, according to the Society of Family Planning’s #WeCount report released in October. Care at brick-and-mortar clinics is still overwhelmingly popular.
The qualitative study about abortion patients examined why they chose to avoid in-clinic care and opt for telehealth abortion providers — either Abortion On Demand, Choix or Hey Jane.
Patients said remote abortion care removed travel barriers, reduced waiting times and cost less than getting the pills in-person. For example, a 15-year-old Latina living in central California said the nearest clinic was two hours away, and she didn’t want to tell her parents she was getting an abortion. A 36-year-old Black woman in New Jersey said there were no abortion providers nearby.
They also said taking abortion medication at home helped them avoid anti-abortion protesters at clinics and being seen in public as an abortion patient. Becker said she was surprised by the latter outcome: “They were fearful of being viewed by other patients in the waiting room, by intake staff, by nurses, by their medical doctors.”
One participant was a 30-year-old Asian woman in Colorado who previously had an in-clinic abortion in Louisiana: “Just imagine living in a red state, and people are screaming and yelling at you and showing you these photoshopped pictures of babies being vacuumed out of women’s wombs.”
Take the case of a 39-year-old white woman from Rhode Island who is married and has a son. Researchers said a logistic hurdle for her was child care, but she also felt ashamed.
“I had to confront a lot of internal biases that I didn’t really even know that I had, where I didn’t deserve an abortion because financially, I could afford another child,” the Rhode Island woman said through tears, according to the study.
And a 19-year-old Latina in New York didn’t want to go to an abortion clinic because of privacy: “I wouldn’t want people to know that I’m having an abortion at the time. It’s still something I’m not really proud of, so I would want it to be as secretive as possible.”
Authors of the study hope the findings can help shape policy on telehealth abortion. Their research compliments quantitative studies that underscore the safety and efficacy of abortion medication.
Complications from medication abortions are rare, but they happen occasionally. Three out of 30 patients that Becker and her team interviewed had mishaps.
She said two patients had to take an extra round of misoprostol tablets to complete the abortion, and another patient said she was afraid to take misoprostol, so she had to get a procedural abortion at a clinic.
“We intentionally sought out complications as part of the study in order to have a more holistic understanding, but I want to be clear that we oversampled,” Becker said. A study published in February 2024 found that 97.7% of telehealth medication abortions were complete, and 99.8% lacked serious adverse events.
Since the study was conducted before the Dobbs v. Jackson Women’s Health Organization decision, Becker said she plans to work on a similar study with trans and nonbinary patients who have had telehealth abortions post-Roe.
While bans have not led to a decrease in abortions, shield laws passed in eight states protect providers and patients from out-of-state prosecutions. California, Colorado, Maine, Massachusetts, New York, Rhode Island, Washington and Vermont allow providers to prescribe abortion pills in states where the procedure is banned by giving them explicit legal safeguards.
The power of those laws is likely to be tested soon. Texas Attorney General Ken Paxton sued a New York abortion provider last month for mailing abortion medication to a patient in his state. Paxton alleged a 20-year-old took the pills at nine weeks of pregnancy, started bleeding severely and went to a hospital, according to Texas Tribune. It’s unclear if the woman completed the abortion.
Several states that allow abortions prohibit them via telehealth. There are bans on the method in Arizona, Nebraska, North Dakota and Wisconsin, according to the Reproductive Health Initiative for Telehealth Equity and Solutions.
Restrictions in Alaska, Georgia, Missouri, North Carolina and Utah require an in-person consultation — this could include going over informed consent paperwork and getting an ultrasound, depending on the state — before providers administer the pills.
Republican lawmakers where most abortions are illegal — Indiana, Texas and Tennessee — have introduced bills seeking to crack down on mifepristone and misoprostol, which are also used to treat pregnancy loss.
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