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Objectives
The Southeastern US has increased restrictions on abortion. Medication abortion provision
via telehealth may connect those in the region to necessary abortion services, but
evidence on implementation of this service, particularly considering state and organizational
policies, is lacking. We explored providers’ understanding and perceptions of existing state-level
and organizational policies related to medication abortion provision via telehealth,
potential impact on their practice, and their perceptions of recent changes to telemedicine
policies nationally.
Methods
Semi-structured interviews with 21 administrators and clinicians in 13 Southeastern
states (September–November 2021) were audio-recorded, transcribed verbatim, and analyzed
using MaxQDA. A codebook was developed based on an initial set of transcripts and
further refined by consensus and assessment of intercoder reliability. Transcripts
were thematically analyzed utilizing constant comparative method.
Results
All participants identified of state policies that constrained their medication abortion
service delivery beyond telemedicine bans. Most respondents felt high anxiety because
of the changing policy landscape and discussed the lifting of Risk Evaluation and
Mitigation Strategy on mifepristone as resulting in little change to their practice.
Most participants discussed adjacent state-level policies, eg, ultrasound viewing
laws, as posing salient barriers to medication abortion provision via telehealth.
Some cited clinic/organizational policies, such as ultrasound waivers, as acting as
buffers to the burdens posed by state-level restrictions and facilitators for provision
of this service.
Conclusions
For participants, state-level telemedicine bans were not the primary barrier to medication
abortion provision via telehealth, with most citing another law making the service
infeasible. In light of the Dobbs v. Jackson Women's Health Organization decision, further attention should be paid to organizational policies, which may
support unbundling of telehealth medication abortion and ensure abortion access for
Southerners.
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Copyright
© 2022 Published by Elsevier Inc.
