Federal, state, and institutional barriers to the expansion of medication and telemedicine abortion services in Ohio, Kentucky, and West Virginia during the COVID-19 pandemic

We aimed to characterize the combined impact of federal, state, and institutional policies on barriers to expanding medication and telemedicine abortion care delivery during the COVID-19 pandemic in the abortion-restrictive states of Ohio, Kentucky, and West Virginia. We analyzed 4 state policies, 2...

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Bibliographic Details
Published in:	Contraception (Stoneham) Vol. 104; no. 1; pp. 111 - 116
Main Authors:	Mello, Kelsey, Smith, Mikaela H., Hill, B. Jessie, Chakraborty, Payal, Rivlin, Katherine, Bessett, Danielle, Norris, Alison H., McGowan, Michelle L.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-07-2021
Subjects:	Abortifacient Agents - therapeutic use Abortion Abortion, Induced - legislation & jurisprudence Abortion, Induced - methods COVID-19 Drug and Narcotic Control Elective Surgical Procedures Federal Government Health Services Accessibility Humans Kentucky Mifepristone Ohio Original Postal Service Public Policy REMS Risk Evaluation and Mitigation SARS-CoV-2 State Government State policy Telemedicine Telemedicine - legislation & jurisprudence Telemedicine - organization & administration West Virginia West Virginia Ohio Kentucky COVID-19 Mifepristone State policy Telemedicine Abortion REMS
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Summary:	We aimed to characterize the combined impact of federal, state, and institutional policies on barriers to expanding medication and telemedicine abortion care delivery during the COVID-19 pandemic in the abortion-restrictive states of Ohio, Kentucky, and West Virginia. We analyzed 4 state policies, 2 COVID-related state executive orders, and clinic-level survey data on medication abortion provision from fourteen abortion facilities in Ohio, Kentucky, and West Virginia from December 2019 to December 2020. We calculated the percent of medication abortions provided at these facilities during the study period by state, to assess changes in medication abortion use during the pandemic. We ascertained that COVID-19-executive orders in Ohio and West Virginia that limited procedural abortion in Spring 2020 coincided with an increase in the overall number and proportion of medication abortions in this region, peaking at 1613 medication abortions (70%) in April 2020. Ohio and West Virginia, which had executive orders limiting procedural abortion, saw relatively greater increases in April compared to Kentucky. Despite temporary lifting of the mifepristone REMS, prepandemic regulations banning telemedicine abortion in Kentucky and West Virginia and requiring in-person clinic visits for medication abortion distribution in Ohio limited clinics’ ability to adapt to offer medication abortion by mail. Our findings illustrate how restrictive medication and telemedicine abortion policies in Ohio, Kentucky, and West Virginia created additional obstacles for patients seeking medication abortion during the pandemic. Permanently lifting federal regulations on in-clinic distribution of mifepristone would only advantage abortion seekers in states without restrictive telehealth and medication abortion policies. State policies that limit access to comprehensive abortion services should be central in larger efforts toward dismantling barriers that impinge upon reproductive autonomy. We find that abolishing the REMS on mifepristone would not be enough to expand access to patients in abortion-restrictive states with telemedicine and medication abortion laws. While the REMS is a barrier, it represents one of several hindrances to the expansion of telemedicine abortion distribution across the United States.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0010-7824 1879-0518
DOI:	10.1016/j.contraception.2021.04.020