Abortion access expands in NH in part due to telehealth

This story was originally produced by the New Hampshire Bulletin, an independent local newsroom that allows NHPR and other media outlets to reprint its reporting.

A recent federal rule change will expand access to abortion care by allowing pharmacies, not just clinics, to dispense abortion pills, which can be used to terminate a pregnancy as early as 11 weeks. But it’s local providers who can provide even greater access with the introduction of telehealth appointments.

This summer, Planned Parenthood of Northern New England began offering patients seeking to terminate pregnancies with medication, rather than a surgical procedure, the option of consulting with a provider via telehealth. If a provider deems abortion medication safe for the patient, the clinic will mail the medication. Previously, patients had to physically visit a clinic to receive it.

Equality Health Center in Concord hopes to roll out a similar program early this year.

Until recently, federal and state regulations made telehealth abortions and mail-order medications impossible in New Hampshire, said Kayla Montgomery, vice president of public affairs at Planned Parenthood of Northern New England.

The state’s 24-week abortion ban required an ultrasound, which must be done at a clinic, until lawmakers lifted it last year. And before the pandemic, Medicaid reimbursed telehealth visits at much lower rates than in-person care, making telemedicine a financial challenge. Legislation passed in 2020 now prohibits this discrepancy in reimbursement rates.

And in 2021, the Food and Drug Administration said it would permanently lift a ban on mail order abortion pills; initially made the rule change during the pandemic, but only as a temporary measure.

Montgomery said among Planned Parenthood of Northern New England patients, about 60% choose a medication abortion over a surgical procedure. But currently, most still come to the clinic for medication abortions; only 10 to 15% are using the new telehealth option, she said.

Montgomery said she suspects that’s partly because of the new option, but also because telehealth isn’t possible or preferred by everyone. For example, medical abortion is not an option after 11 weeks of pregnancy or for patients with risk factors or who require an ultrasound.

“People really understand that, if you’re early in your pregnancy, if you don’t have a lot of risk factors, many are choosing medication abortion because they can have their abortion in the comfort of their own home,” she said.

But it may not be the right choice for someone who doesn’t have a safe place to have an abortion outside of the clinic. And a medical abortion can take longer, a day or two, versus an hour for a surgical abortion and recovery.

“It’s really all about patient choice,” Montgomery said. “It’s about what works best for each individual patient. We want to work with all of our patients to make sure they have the choices they need and that work best for them.”

What is a medical abortion?

Medication abortions are on the rise in the United States, from 39% of abortions in 2017 to 54% in 2020, according to a 2022 report from the Guttmacher Institute.

The process requires two medications, mifepristone followed by misoprostol. Unlike the “morning after pill,” which prevents pregnancy, mifepristone and misoprostol terminate pregnancy by blocking the progesterone needed for pregnancy to continue.

The patient can expect cramping and bleeding. Planned Parenthood compares the experience to having a really heavy, crampy period and describes it as similar to a miscarriage.

Who is eligible for a telehealth medication abortion?

Planned Parenthood of Northern New England and Equality Health Center offer abortion pills up to 11 weeks after the first day of a patient’s last period. Equality Health Center will reduce the time period for the discontinuation of telehealth medicines to eight weeks.

After 11 weeks, surgical abortions are the only option to end the pregnancy.

Patients should not require lab work or ultrasounds, and they should have a stable, safe place to undergo the process, which can take a few hours but may take longer. Providers can only treat patients in a state where they are licensed to practice medicine.

For Planned Parenthood of Northern New England, whose providers are licensed only in New Hampshire, Maine, or Vermont, a person must live in one of those states or must travel here for an abortion at the clinic, including discontinuation of medication.

Montgomery said their providers cannot mail abortion pills to people outside those three, such as those who live in states that have severely restricted access to abortion.

How do telehealth medication abortions and mail-order pills work?

In many ways, a telehealth appointment is similar to a clinic visit, providers said. A clinician reviews a patient’s medical history and discusses termination options and the specifics of a medical abortion. If a provider determines that a medication abortion is safe for a patient, the person can pick up the drug at the clinic or have it mailed to them.

The Food and Drug Administration’s January rule change now allows pharmacists for the first time to dispense mifepristone, the first drug required for a medical abortion, to someone with a prescription from a health care provider. The second drug, misoprostol, was already available at the pharmacy.

The New York Times reported Thursday that CVS and Walgreens have said they will offer mifepristone where abortion remains legal, which includes New Hampshire up to 24 weeks. After that, an abortion can only be performed if a fetus has a fetal abnormality.

Abortion will come back before lawmakers

Of the more than 800 bills the Legislature is expected to take up this session, none so far target telehealth medication abortion or mail-order abortion pills. But there are some taking aim at the state’s abortion law and access to abortion and reproductive health.

One bill would ban abortions after a fetal heartbeat is detected, which can be as late as six weeks. The same legislation failed in 2020 and 2022. Another would have required a patient to give “informed consent” before terminating a pregnancy, which could include showing patients images or illustrations of a fetus in their state of labor. pregnancy. Similar legislation has failed several times since 1992.

One bill is not explicitly related to abortion, but may come into play in some abortions. Under the legislation, the text of which has not been released, medical providers would have to give every baby born alive life-saving medical treatment.

This will affect parents whose baby is born alive during or after a miscarriage, but will not live long. Lawmakers heard from parents last session who chose abortion because their fetus had a fatal abnormality but wanted to keep the baby until it died. Similar legislation has failed at least four times since 2016.

Other bills would expand or protect access to abortion.

Democrats have introduced legislation that would repeal the 24-week abortion ban, a bill that would ban further restrictions on abortion and a proposed constitutional amendment establishing the right to make personal reproductive decisions.

Gov. Chris Sununu has said he won’t support further restrictions on abortion, and House Majority Leader Jason Osborne, an Auburn Republican, has said he doesn’t believe House Republicans will pass legislation that would try to do this.

Montgomery said Planned Parenthood of Northern New England is not relying on those statements.

“It was Governor Sununu who in 2020 said there would be no abortion restrictions and he signed an abortion ban,” she said. “We will never stop fighting, we will never back down. We need to protect access, we need to expand access. No, no matter who says what, no matter what comes from the politicians, we know we’re going to have a fight on our hands every year.”

The New Hampshire Bulletin is part of the State Newsroom, a network of grant-supported newsrooms and a coalition of donors as a 501c(3) public charity. The New Hampshire Bulletin maintains editorial independence. Contact editor Dana Wormald with questions: [email protected]. Follow the New Hampshire Bulletin on Facebook and Twitter.