Telemedicine for Fighting Abortion: The Case for Out-of-State Control and the Issues of State Laws in Colorado, Illinois and New York

Women travel out of state for abortions in clinics in Colorado, Illinois and New York. But the shift to telemedicine makes sense for practical reasons. First, having an abortion with pills at home, which has the physical effects of miscarrying, is as safe and effective in the first trimester as going to a clinic.

In an interview with NPR, Rodriguez said her goal is to reduce the number of miles people have to travel to access care.

“What we are seeing now is that if a state has banned abortion, then medication abortion is unavailable. And I think we’re going to see how this tension plays out between the FDA’s authority over drugs and devices and the state laws,” she said. “We may see some court cases around this very issue as to FDA’s authority and state law.”

An increase in patients traveling from across the region is materializing much more quickly than anticipated, Rodriguez said. “We just need more access points.”

One of the first tasks will be to determine the best routes for the mobile clinic. The organization is looking at data to figure out where patients are coming from and look at locations as possible stop-off points. McNicholas said safety and security was an important consideration for patients and staff.

It’s also notable that abortion by telemedicine has risen in states that have not restricted abortion access, suggesting that more women are choosing it for “comfort and privacy” as well as necessity, said Abigail Aiken, a public health researcher at the University of Texas at Austin and a co-author of the study of the Aid Access data.

There are likely battles between states with differing abortion laws as a result of the amendment. A Missouri state lawmaker proposed to allow people to file lawsuits against people who help women get abortions out of state because she thought they were “abortion tourism.” Legal experts say it’s not clear how conflicts between state laws will be resolved in the future.

As more states pass abortion restrictions, the Guttmacher Institute expects the number of clinic closings to increase. She says that there are only 15 states that are going to ban abortion at this point in time.

“I have had teenagers with chronic medical conditions that make their pregnancy very high risk and women with highly desired pregnancies who receive a terrible diagnosis of a fetal anomaly cry when they learn that they can’t receive their abortion in our state and beg me to help them,” she told President Biden and members of the White House Task Force on Reproductive Healthcare Access this week.

“Imagine looking someone in the eye and saying, ‘I have all the skills and the tools to help you, but our state’s politicians have told me I can’t,’ ” she added.

A Southern Hemophilic Case in Wisconsin, where Anomalous Urinary Absorption is a Public Prostate and is an Assisted Living Facility

While 40 of the clinics in these states are still open for other services, the Guttmacher analysis found 26 clinics had completely closed down, which means they might never reopen.

“These clinics probably moved their medical supplies to other facilities because they did not have staff anymore,” Jones says. “So it’s not like they could open their doors tomorrow if these bans were lifted.”

If not treated correctly, a patient from the southern states can cause severe hemorrhage if an abnormal uterus is not treated. The patient had already tried to get care in her own state and elsewhere before coming to Illinois.

It was more complex than required because of the length of time that had passed before the patient sought care.

The situation: A 31-year-old mother of two, Kristen Petranek decided to stop trying to have a third child because of the risks she could face during a pregnancy in Wisconsin, where abortion is banned.

Petranek, 31, and her husband Daniel have two children – a 7-year-old son and 4-year-old daughter. She says that her pregnancies were risky because of her diabetes, and that it was hard on her body. But she and her husband still planned to have more kids – they wanted three. “I have three brothers and he has one brother – we kind of liked [a number] in the middle of that,” she says.

A post-Roe era when abortion laws were enforced: NPR’s Melissa Petranek reports on her experiences with the Wisconsin Supreme Court

She went back to wait for the problem to be solved. It was the second time she’d miscarried and she was anxious about possible complications. She says that the days were very hard to take because she suffered through nausea, extreme fatigue, abdominal pain and backaches. She started to have a cold over the next few days.

We want to hear from you: NPR is reporting on personal stories of lives affected by abortion restrictions in the post-Roe era. Do you have story about how your state’s abortion laws impacted your life? Share your story here.

Resting under a heating pad, she tried to distract herself from the miscarriage by scrolling through Twitter, and that’s when she saw the leaked Supreme Court opinion indicating that Roe v. Wade could imminently be overturned.

She knew what that would mean in Wisconsin – an old law on the books could snap back into place, making abortions illegal. Petranek had no plans to end her pregnancy, she was focused on her family. But she realized right away that if abortion became illegal, that could affect how doctors cared for her if anything went wrong.

Petranek, a pregnant mother with diabetes, has an elevated risk of birth defects. She says she is always a risk despite her diabetes being well managed. If doctors are afraid of being accused of breaking the law, it can be difficult to access hospital care for abortion related problems.

NPR reported on two cases in which women were refused treatment when their waters broke too early – one had to fly out of state for care, the other had to wait until she was showing more signs of infection. And a survey of health care providers by the Texas Policy Evaluation Project found that one hospital was no longer treating some ectopic pregnancies, even though they are never viable and can be life-threatening if left untreated.

Source: https://www.npr.org/sections/health-shots/2022/12/09/1141404068/wisconsin-abortion-law-pregnancy-risk-miscarriage

How doctors decide what to do, when to give up, or when to take a D&C, or how to deal with the consequences of the Wisconsin abortion ban

She says she knew she couldn’t try again. It was just a decision that I will not put myself through that again if I have doubts about coming out the other side,” he said.

The same procedure that’s used for many abortions is used to stop Petranek from miscarrying again.

She thinks her providers would be hesitant to give her a D&C if she got pregnant again, since they would be afraid to be charged with violating the abortion ban.

She says that the fact that her pregnancies have been physically and emotionally draining weighs on her.

The state law was written in 1849, a year after Wisconsin became a state. The law classifies abortion as a felony, punishable by up to 6 years in prison and a maximum fine of $10,000. The only exception is “to save the life of the mother” – there is no exception for rape or incest or to preserve a patient’s health.

Democratic Governor Tony Evers supports the lawsuit against the 1849 ban. The Republican-controlled Legislature made it clear they wanted it to stay in place, despite the fact the governor had called for a special session to overturn it. Assembly Speaker Robin Vos and Senate Leader Chris Kapenga were the only Republicans who did not give an interview to NPR.

In Wisconsin, Cutler says she’s seeing similar problems unfold. “There are delays in care because physicians are hesitating, thinking twice, calling legal counsel, conferring to make sure – where the direction from a medical perspective seems very clear, but is it legal?”

What’s at stake: Decisions about how many children to have, when to start trying, how close in age children should be spaced – are usually not made by individuals alone, explains Dr. Abigail Cutler, an obstetrician-gynecologist and professor at the University of Wisconsin’s medical school.

She says decisions are made with other people in the context of families, romantic relationships, extended family or friends of faith leaders. She says a new element to be added to the equation now is whether people have access to comprehensive healthcare during their pregnancies and where they live.

How people process risks is different. “A single mom [with] four kids at home – their tolerance for incurring even the smallest amount of risk that could be associated with even just a healthy pregnancy is going to be potentially lower than someone who really desperately wants to become pregnant and is really willing to do whatever it takes in order to have a child.”

Jenny is a professor of Gender and Women’s Studies at the University of Wisconsin- Madison and the director of the Collaborative for Reproductive Equity.

She says that pregnancy intentions are nuanced. “There are people who are really desperate to get pregnant, there are people who are really desperate to not be pregnant, and most people are somewhere in between,” she explains, and it’s a challenge to capture that nuance in data.

Source: https://www.npr.org/sections/health-shots/2022/12/09/1141404068/wisconsin-abortion-law-pregnancy-risk-miscarriage

A Woman’s Perspective on Health Care in Pregnancies: Kristen Petranek, a Wisconsin Right to Life, and her Loss

There is a chance the state legislature will change the law if the case goes through the courts. “We have a large majority in both state houses that are pro-life, that are in favor of the current law,” says Skogman of Wisconsin Right to Life. It’s important that women and medical providers understand that the medical emergencies are not in violation of the law.

Cutler says that the concern Petranek feels about potentially not being able to get timely or appropriate care during a pregnancy complication could be very real.

The provision of health care related to pregnancies can be overstated due to the level of confusion and uncertainty created by this.

She says that it was written by men and that it was written at a time when C-sections were performed without anesthesia, and that problems of pregnancy and labor were poorly understood. In the early 20th century, women were second class citizens with few to no rights.

The patient’s perspective: Kristen Petranek and her husband have started regularly using birth control – condoms for now, but she’s looking into longer-term options like a vasectomy for her husband or an IUD for herself.

Petranek is resolute about the decision, but also sad, and reminders of what she’s lost are everywhere. If she hadn’t miscarried, she would have had a baby over Thanksgiving this year. “It was good that I had the distraction of the holiday but I kept thinking, ‘I would have been holding a newborn right now,’” she says.

She says she thinks about it every day – the loss of the pregnancy this spring, and the loss of the chance to add to her family in the future. “We wanted a baby and we wanted to have a third child,” she says, through tears.

And she says, she finds herself looking at her 4-year-old daughter in a new way. “I have to reconcile with the fact that she’s truly, always going to be my youngest child now, when I always pictured her as a big sister someday.”

Do doctors need prescriptions? Comment on the FDA’s latest update of abortion restrictions and their role in the fight against a disease that punishes women

If people who favor abortion restrictions understand how their actions can affect people like hers, then they might be willing to change their minds. She explains that she was raised an evangelical Christian – she now goes to a Presbyterian church every Sunday.

The American Society of Health-System Pharmacists said in a statement that there is no requirement to stock the medication in the FDA’s change.

According to a professor of law at the University of Michigan, it isn’t clear whether or not any pharmacy will do anything to increase access to medication abortion.

The medications can be taken up to 11 weeks after the first day of menstruation in some states. Telehealth prescriptions are an option in some states, or a person could travel to a state where abortion is legal to get the pills.

More than half of all U.S. abortions are medically induced through a two-pill regimen that requires a prescription but does not involve surgery. And since Roe v. Wade was overturned in June, rates are expected to increase.

“Because there are manifold ways in which recipients in every state may lawfully use such drugs, including to produce an abortion, the mere mailing of such drugs to a particular jurisdiction is an insufficient basis for concluding that the sender intends them to be used unlawfully,” the opinion added.

The Supreme Court ruling led to a promise by the Attorney General to work with the FDA and other federal agencies to protect access to such drugs.

At the beginning of the pandemic, the agency removed the mandatory face-to-face with doctors and allowed them to prescribe the pill from home. This week the FDA said that after a review, the restrictions were no longer necessary.

Two drugmakers that make brand-name and generic versions of abortion pills requested the latest FDA label update. Agency rules require a company to file an application before modifying dispensing restrictions on drugs.

In 2000 the FDA gave the go-ahead for the drug mifepristone to be used to end a pregnant woman’s pregnancies up to 10 weeks. The first thing Mifepristone does is dilate the cervix and block the hormone prostaglandin, which is needed for a pregnant woman. The uterus contracts and expels pregnancy tissue after being taken for 24 to 48 hours.

The Mayo Clinic lists excessively heavy vaginal bleeding and unusual tiredness or weakness among the more serious side effects of mifepristone that would require immediate medical attention. Still, the physicians and medical societies say medical complications are very rare.

Several FDA-mandated safety requirements remain in effect, including training requirements to certify that prescribers can provide emergency care in the case of excessive bleeding. There is a certification for pharmacy that distributes the pills.

Does the FDA Banned Abortion Update Restrict or Prevent It, or Is It Happening at a Telemedicine Pharmacy?

“I don’t think it will have an impact in states where abortion is banned, I think that’s the answer,” he said. “I don’t see any real effect there.”

It’s not clear which other pharmacies will seek certification or what impact it will have on abortion access in places where it’s banned or restricted.

Walgreens stated in a statement on Wednesday that it is evaluating its pharmacy network and will serve products that have extra FDA requirements and will comply with federal and state laws.

“At the onset of the pandemic, Honeybee Health quickly became the first digital pharmacy to supply and ship medication abortion. In response to the FDA’s adjustments to the REMS program, we are proud to work closely with our manufacturer to set the high standards required for certification and we will partner with the majority of telemedicine abortion providers in the US. REMS is the Risk Evaluation and Mitigation Strategy for Mifepristone.

It will take some time for many pharmacies to find out if they should try the certification process.

In places where abortion was banned or heavily restricted before the FDA update, it remains banned or restricted, said Elizabeth Nash, a principal policy associate of state issues at the Guttmacher Institute, a reproductive-health nonprofit.

“We don’t believe that anyone should be forced to travel in that way, and certainly, as this moves forward, there are a lot of very smart lawyers who are looking at the question of how they’ll be incorporated into drugstores and pharmacy chains, and where that can happen – and how these different federal and state provisions interplay,” she said.

He inquired if a state that was prosecuting someone for diversion would have access to those records. Because if they do, then that is a disincentive to providing it to people in states that are banning it.”

Abortion Pills Should BE Easier to Get That Doesnt Mean That They Will Be Be Be That It Isn’t: The FDA’s decision to require an in-person exam is a disaster waiting

There is a doctrine that states can’t enforce because it undermines the purpose or objectives of federal law.

“Many people have difficulty accessing this care because of things like transportation or having time off of work to go to a clinic to get this care so this is really going to open the doors for them,” Dr. Kristyn Brandi, a member and fellow at the American College of Obstetricians and Gynecologists told NPR.

She said that the FDA’s conclusion that patients don’t have to see a doctor in person if they don’t want to could pave the way for providers who were previously nervous about obtaining certification.

Sue Liebel, director of state affairs for the Susan B. Anthony Pro-life America, an organization that calls itself “the political arm of the pro-life movement, called the more lax rules “a disaster waiting to happen.”

“It is just super reckless that the FDA would peel back these safety regulations [requiring] an in-person exam. I find it heartless that women’s health and safety was not taken into account,” Liebel told NPR.

She said that more people would end up in the emergency room. The FDA temporarily lifted the in-person mandate, but she was unable to point to any recent studies that would show an increase in ER visits.

“I think this next policy session is going to be very fascinating,” she said. “We’re in some new territory here with the decision. t’s going to be a mixed bag to be honest with you in terms of what states will try do and see what works.

Source: https://www.npr.org/2023/01/05/1147044290/abortion-pills-should-be-easier-to-get-that-doesnt-mean-that-they-will-be

Are people going to the Emergency Care Centers going to be safer than expected? “It’s been a delight to see what is going on,” she said

There is no data showing that people are going in waves for emergency care after taking medication and that’s because there is a great track record of being safe,” she said.

She also notes that clinical care is not going to change very much. “Patients will still be evaluated by experienced clinician. They’ll go through counseling. They’ll be able to talk about whether or not this is the best choice for them.”

The only difference, moving forward she explained, is that in the most dire situations they will no longer have to drive long distances for an exam or wait days to obtain the vital medication. They are going to have easy access to it.