Potential Impact of Telemedicine for Medication Abortion Policy and Programming Changes on Abortion Accessibility in the United States

Jane W. Seymour, PhD, MPH; Terri-Ann Thompson, PhD; Dennis Milechin, GISP; Lauren A. Wise, ScD, SM; Abby E. Rudolph, PhD, MPH

Disclosures

Am J Public Health. 2022;112(8):1202-1211. 

In This Article

Results

Of the 241 health centers operating in 2018 that did not offer abortion care, 95 (39.4%) were located in states that banned TMAB services (Table 1). As shown in Figures 1 through 3 and Table 1, TMAB bans were common in states in the Southeast and the middle portions of the United States (Table A, available as a supplement to the online version of this article at https://www.ajph.org).

Figure 1.

Drive Time Isochrones for Current Abortion Provision Scenario: United States, 2018
Note. Drive times were 30, 60, and 90 minutes, with 65.3%, 80.5%, and 88.9% of US women 15–44 years old living within the given drive time, respectively.

Figure 2.

Drive Time Isochrones for TMAB Expansion Abortion Provision Scenario: United States, 2018
Note. TMAB = telemedicine for medication abortion. Drive times were 30, 60, and 90 minutes, with 68.3%, 82.6%, and 90.1% of US women 15–44 years old living within the given drive time, respectively.

Figure 3.

Drive Time Isochrones for TMAB Ban Removal Abortion Provision Scenario: United States, 2018
Note. TMAB = telemedicine for medication abortion. Drive times were 30, 60, and 90 minutes, with 70.9%, 84.7%, and 91.7% of US women 15–44 years old living within the given drive time, respectively.

The drive time isochrones for all 3 drive time measures of accessibility (i.e., 30 minutes or less, 60 minutes or less, and 90 minutes or less) across the 3 provision scenarios (i.e., current, TMAB expansion, and TMAB ban removal) are depicted in Figures 1 through 3. In the United States in 2018, 65.3%, 80.5%, and 88.9% of women 15 to 44 years old lived within 30, 60, and 90 minutes of an abortion-providing facility, respectively. Under the TMAB expansion scenario, 68.3%, 82.6%, and 90.1% of women lived within a 30-, 60-, and 90-minute drive time, respectively. In the TMAB ban removal scenario, 70.9%, 84.7%, and 91.7% of women lived within a 30-, 60-, and 90-minute drive time, respectively.

Across all scenarios and drive times, a greater proportion of women living in urban census blocks than rural census blocks were within the given drive time (Table A, available as a supplement to the online version of this article at https://www.ajph.org). Abortion accessibility across all 3 scenarios and drive times varied widely between states and regions of the country (Figures 1–3 and Table A). For example, in the TMAB expansion scenario for a 30-minute drive time, accessibility ranged from 3.9% in Wyoming to 100% in the District of Columbia.

Both TMAB expansion and ban removal resulted in expanded abortion accessibility among US women 15 to 44 years old relative to the current accessibility scenario. The smallest percentage point increase in accessibility was a 1.25 percentage point difference between the current and TMAB expansion scenarios at a 90-minute drive time, meaning that an estimated 781 556 additional US women 15 to 44 years old who did not live within a 90-minute drive time in the current scenario would live within that drive time given this programming change. The largest percentage point increase in accessibility was 5.66 for the difference between the current and TMAB ban removal scenarios at a 30-minute drive time, meaning that an estimated 3 530 423 additional US women 15 to 44 years old who did not live within a 30-minute drive time of an abortion-providing facility would live within that drive time given this policy change (Table 1). Across all drive times and scenarios, women in rural census blocks had greater increases in accessibility than those in urban census blocks.

Generally, in states with TMAB bans, TMAB expansion resulted in little if any change in accessibility, and in states without TMAB bans the expansion and ban removal scenarios resulted in very similar if not the same accessibility. However, there were exceptions for specific states. For example, in Virginia, Illinois, Kentucky, and Ohio, states without bans that border states with bans, the TMAB ban removal scenario resulted in increases in 30-minute accessibility relative to the TMAB expansion scenario. Similarly, in North Dakota, Oklahoma, West Virginia, Michigan, Indiana, and Wisconsin, despite the TMAB bans in these states, the TMAB expansion scenario resulted in a 30-minute accessibility increase. In both cases, these increases that contradict the state's ban status were due to accessibility increases in nearby states with the opposite ban status (Figures 1–3 and Table 1).

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