Champions for abortion pill access claim that abortion drugs are medical care, that it is a “simple healthcare intervention,” and that we do not need to worry about the Food and Drug Administration (FDA) rolling back safety protocols.
But the truth is, it’s become nothing more than online commerce—not telemedicine. An April 7 ruling granted the FDA’s request to pause a case challenging access to mifepristone, which is used in abortions while acknowledging the harm these drugs cause.
As a board-certified OB-GYN, I know what good telemedicine looks like and how it can fill gaps, especially in healthcare deserts. Both pro-life and pro-abortion physicians should be able to agree that access cannot trump all other stipulations for care, especially for a drug that assumes (and requires) clinician interface of some kind.
In real telemedicine, the patient is still seeing a clinician. One of the upsides of it is that it lets you see your healthcare professional without going to their office. For many patients, this can eliminate barriers to care.
But this only works if actual medical oversight occurs and if the condition being treated is not something that requires an in-person evaluation to fully assess the status of the patient.
At a minimum, if abortion drugs are to be dispensed via telemedicine, we assume many givens. First, a live clinician interface (or at a bare minimum, review of a patient’s clinical information by a qualified medical professional before the drugs are dispensed). Second, confirmation via ID of patient identity and age. Finally, appropriate screening for potentially life-threatening contraindications, accurate knowledge of the patient’s last menstrual period with gestational age confirmed and counseling provided specific to her situation. All of these assumptions are crucial to minimize the risk of harm to women.
These assumptions align with guidance regarding abortion drug use from the American College of Obstetricians and Gynecologists (ACOG), which recommends confirmation of “pregnancy and estimate gestational age,” “discussion of when patients should contact their clinician in the case of heavy bleeding” and counseling “in the event of an unsuccessful medication abortion.”
These are life or death assumptions—always for one of my patients and sometimes for both. Recognizing this, an investigation has been launched into the companies that produce these drugs, and a bill has been introduced to protect women from them as well.
Abortion pill providers specifically state that a medical professional will look at any patient’s information before the patient is given a prescription.
To test this theory, I recently visited a “Plan C” website to confirm that ACOG’s guidelines and the site’s own promise were employed while accessing abortion drugs via “telemedicine.”
In my request, I claimed to be a 13-year-old with an IUD in place who was on blood thinning medications, suffered from anemia, had undergone three previous C-sections, and had a prior history of ectopic pregnancy.
This was a purposefully ridiculous combination of conditions, any one of which should have set off warning flags. Despite the life-threatening risks of taking mifepristone with these conditions, I received an email requesting payment and confirmation of my address for the pills to be shipped within two minutes of submitting the form. This was despite the fact that the website promised I would not receive this until a healthcare professional had reviewed all of my information.
The screening required no steps to verify if I was even ordering the pills for myself and no basic identification of any kind. I was allowed to continue after merely acknowledging I’d read the associated warnings, and the website also let me change my answers and proceed immediately to order after I received warnings on different responses.
At the end of the process, I was asked to sign a patient agreement acknowledging I was aware of potential side effects that hadn’t been mentioned previously, including the risk of infection and to check a box saying I’d discussed them with my medical provider.
Throughout the process, I hadn’t talked to anyone, much less a physician I could contact if something went wrong. Furthermore, the website didn’t require a doctor’s note or even the name of my physician.
It was as if the FDA and ACOG’s safety guidelines suddenly stopped applying once abortion pills were available online.
Patients deserve better.
Permitting an anonymous person to run a website with no liability for distributing these drugs to someone they clearly shouldn’t is not just negligent—it’s criminal.
All due diligence falls on the girl or woman who assumes that institutions like the FDA, ACOG and the World Health Organization are promoting safe, accessible care. Normally this due diligence is provided by a physician who is there to have thorough discussions with patients about their individual risks, answering questions and providing ongoing care. Removing physicians and safety protocols from the equation is a far cry from healthcare in any sense.
Women and girls across all 50 states in difficult circumstances aren’t getting healthcare through telemedicine. All they’re getting is a bill.
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