SCOTT SIMON, HOST:
Some health care providers are gearing up to provide access to abortion pills online. These new efforts cropped up during the pandemic, thanks to a boom in telehealth. And now, with abortion restrictions looming, there's likely to be even more demand. NPR's Pien Huang reports.
PIEN HUANG, BYLINE: Earlier this month, on the day the Supreme Court's draft ruling that could end nationwide protection of abortion rights was leaked, a woman named Nora was on the couch in her apartment getting through a medical abortion.
NORA: And I was bleeding through a pad about every 40 minutes. And I would take panty liners - I made, like, these caterpillar pads just to cover all the bases. They lasted maybe 40 minutes.
HUANG: We're just using Nora's first name for personal safety. She lives in upstate New York.
NORA: And I've always wanted kids, but I'm 22, and I am poor (laughter). And I just can't even wrap my head around, like, just going to the doctor, getting an ultrasound. All of these things are very expensive. And if you don't do that, you are charged with criminal neglect over a baby that you could be forced to have.
HUANG: For Nora, deciding to end the pregnancy was hard, but getting the FDA approved abortion pills was not. She got them online through a medical provider called Aid Access. It's one of a handful of telehealth abortion services that have sprung up in recent years. They're named things like Hey Jane and Abortion On Demand, and they've benefited from pandemic changes that allow abortion pills to be sent through the mail and taken at home. The FDA made these changes permanent last year. Now the possibility of abortion restrictions looms over parts of the country. Robin Tucker, a nurse practitioner and midwife who works in D.C., Virginia, Maryland and Maine, says these telehealth services are seeing a big surge in demand.
ROBIN TUCKER: The future of abortion access is going to be getting pills out there and getting pills in the hands of people. That's, like, one of the interventions that can provide the most autonomy in this kind of environment where people are going to lose reproductive rights.
HUANG: Abortion pills in the U.S. are a combination of two drugs, mifepristone and misoprostol. Together, the pills block a hormone needed to continue an early pregnancy and get the uterus to expel it. They've been approved since the year 2000 and now account for more than half of all U.S. abortions. The pills are considered safe and effective for ending pregnancies up to 10 or so weeks. Nora was six weeks along when she realized that she was pregnant, and she found Aid Access through social media.
NORA: I was on TikTok maybe the day I decided about aborting, and one of the comments was like, hey guys, you should check out Aid Access. It's an organization run by female doctors.
HUANG: The rest of the process was also virtual. She filled out an intake form, which asked questions like, how far along is your pregnancy, and do you have an IUD in place? A clinician was on the other end, reviewing Nora's answers to make sure that she was a good candidate for a telehealth abortion. And they checked her ID to make sure that they were complying with the laws in her state. Right now, abortion is still legal in every state, but telehealth abortions are not. Dr. Jamie Phifer is the founder of Abortion On Demand, a telehealth provider that operates in 21 states.
JAMIE PHIFER: Any restrictions on abortion care within a state - whether it's gestational age limits, state-mandated ultrasound, extended waiting periods - no matter how egregious those restrictions are, they also apply to telemedicine abortions within that state.
HUANG: States like Texas, Tennessee and Missouri have explicitly banned telehealth abortions. Other states have some in-person requirements. Alina Salganicoff, director of Women's Health Policy at the Kaiser Family Foundation, says there are many gray areas. Can a patient see a doctor in a different state? Can friends send pills across state lines? And how will any of this be enforced?
ALINA SALGANICOFF: We really are moving into a new zone. I think it's going to be challenging for providers. I think it's going to be challenging for patients. And I think we're going to see a lot of litigation as these cases move forward.
HUANG: In states where telehealth abortions are not legal, Aid Access has a workaround. They have an international doctor based in Europe who sends abortion pills from a pharmacy in India. It's a method the FDA finds very concerning, and it also has medical drawbacks. An Aid Access doctor who asked us not to use her name to protect her family says getting the drugs from India can delay abortions by several weeks. She says Aid Access and other providers of abortion services are pushing for a different solution. They want the states they work in to protect them if they prescribe across state lines.
UNIDENTIFIED DOCTOR: We're really trying to lobby the state to pass those assurances that my license will not be in jeopardy, my malpractice will not be in jeopardy, and that I will not be extradited to another state and prosecuted because these are criminal and civil penalties that we're looking at.
HUANG: Legislators in California, Washington and Connecticut have passed or are thinking of passing laws to protect their clinicians from liability. For Nora, who lives in New York, every step of getting the telehealth abortion was totally legal, but she still felt like she had to hide what was happening.
NORA: It was very lonely even though I have, like, a monstrous unit of support. It was still very lonely, so I'd send emails being like, I'm worried (laughter).
HUANG: She sent panicked messages to Aid Access, and they wrote her back every time, even though it was a no-response email address. Christie Pitney, a clinician with Aid Access, says the service prides itself on providing discreet abortions, very few questions asked. But it's not the ideal.
CHRISTIE PITNEY: So I hate that we're having to work in a society where we needed these workarounds, but I appreciate that they're available.
HUANG: Pitney prefers that people had open access to abortions, both in-person and online, in all 50 states. Still, she expects things to go further underground if the Supreme Court does follow through with striking down Roe v. Wade.
Pien Huang, NPR News.
SIMON: Mara Gordon co-reported this story.
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