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Markkula Center for Applied Ethics

Telemedicine Abortions Leading Health Equity

A pregnant Black woman sitting with laptop and reading about pregnancy online. By AnnaStills_Adobe Stock

A pregnant Black woman sitting with laptop and reading about pregnancy online. By AnnaStills_Adobe Stock

Kyla Nuñez-O’Leary ’23

AnnaStills/Adobe Stock

Kyla Nuñez-O’Leary is a public health science major with minors in biology and Spanish studies and is a 2022-23 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.


During the COVID-19 pandemic, patients and providers were forced to find new and innovative ways to connect with each other. Unlike many other medical fields, women’s health remains a contentious issue, and thus advances in the field, especially those surrounding abortions, are often met with political resistance. However, during the COVID-19 pandemic, in the midst of stay-at-home orders, vaccine development, and mandated vaccinations, women’s health was relieved of some political pressure. In this time frame, consultations and administration of medical abortions–those that are conducted using medications, not surgical means–began happening over telemedicine. 

Prior to the COVID-19 pandemic, medical abortions made up about 40% of all documented abortions conducted in the US. According to the CDC in 2020, “the highest percentage of abortions were performed by early medical abortion at ≤9 weeks’ gestation (51.0%).” Many people were able to access safe abortions from their own homes due to broadened telemedical services. Ironically, people had more access to safer abortions during a massive pandemic, without the logistical issues that present themselves with attending appointments in person. As the United States makes its way out of the COVID-19 pandemic, the solutions found along the way are being integrated into the current health care system. Medical abortions’ accessibility via telemedicine should be included in this integration, especially as women’s rights are under attack and seem to be reduced with every court decision. 

The Dobbs decision disproportionately affects women of lower socioeconomic status and women of color. By failing to protect a woman’s right to choose and making the use of bodily autonomy a state’s decision, women’s health has only become further politicized. Policies that increase women’s access to health care are vital in a time where the right to bodily autonomy is uncertain for many. Additionally, telemedicine medical abortions have similar risks to in-person medical abortions. Patients are also able to take the medications in the comfort of their own homes and do not have to face hostile demonstrators outside of women’s health clinics, the uncomfortable nature of exam rooms, or the risk of being seen and retaliated against for seeking care. Currently, individual states control a woman’s access to medical abortions. Providers may not provide care to patients outside of the state for which they are licensed, which limits promotion of health equity. To combat this issue, organizations and individuals titled “pill fairies”, send out medications required for abortions across state lines. These communities are built around helping women in need who are not supported by their state governments. 

Post pandemic, face-to-face interactions are sought after and provide a sense of endearment that has been long-missed. Thus, physician-patient relationships stand as points of contention. Although, to offer an additional telemedicine service is not to take away from in-person services, it only supplements them. Providing patients with an opportunity to see their physicians in a comfortable and safe location only benefits a patient’s ability to practice autonomy and a provider’s ability to ensure beneficence. Telemedicine has proven to be a viable option for providing care to patients, while maintaining minimal maleficence. According to Endler, et. al, patients and providers both report that telemedicine medical abortions have provided, 

“greater flexibility, greater access to physicians, increased efficiency of resources, fewer cancellations and delays, being able to ensure access to medical abortion due to earlier access to services and shorter [gestational age] at abortion, and reduced travel times for patients.”  

As people try to remedy issues of women’s health care accessibility by finding innovative solutions, it is vital to recognize the structural limitations in place. For example, internet access has become a necessary public health good, like clean water, housing, and education. Women in rural, tribal, and low-income communities are much less likely to access the internet, thus less likely to access a medical abortion via telemedicine. Moreover, Black, Latinx, and Indigenous communities are disproportionately represented within the population of 77 million Americans who do not have reliable access to the internet. Throughout the pandemic, Black, Latinx, and Indigenous communities were further disadvantaged as everything moved online, except for essential services–which often required the same communities to continue working without hazard pay. Ultimately, this becomes a justice issue as essential workers may be unable to access health care services, due to economic disparities, but continue working to provide upper classes with necessary labor. Denying access to the internet, ultimately denies people access to one of the greatest achievements in health care accessibility–telemedicine appointments. 

Historically, women, especially those of color, have been treated as second-class citizens within medicine. Currently women in rural, tribal, and low-income communities are less likely to have access to regular in-person obstetric and gynecological care and the resources necessary to access online care. In order to seriously support a woman’s right to choose, all women must be supported–not just those that have consistent access to the internet or live in states without medical abortion restrictions. Human rights issues, like that of bodily autonomy for women, is a starting point for ethical actions, not a finish line. In order to achieve justice those rights must be accessible to all people; health equity must be the ultimate goal. Telemedical abortion access provides the ability to take ownership of one’s life and body from the comfort of personal homes, while benefiting clinics and providers alike. It is vital that we search for more solutions like telemedicine medical abortions, and do not lose sight of health equity for all as a goal.

May 30, 2023

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