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Policy changes that facilitated telemedicine abortion


Despite all of the benefits of telemedicine for abortion, and the safety of the procedure (complication rates for medication abortion are less than 1%, and studies have shown telemedicine is a safe and effective way to deliver abortion care), models like Hey Jane’s were in legal / policy limbo until very recently.


That’s because mifepristone, one of the two key medications in the procedure, has been highly regulated by the FDA. Under current regulations, mifepristone has to be dispensed in a hospital or clinic – it can’t be picked up at a pharmacy like most other drugs. There is wide consensus that this restriction is based in politics, not in medical science – mifepristone is extremely safe, the pills are anyway taken at home, and most hospitals and clinics don’t stock drugs themselves, so this requirement limited who could provide and access medication abortion services, with particular impact on low-income women.


When the pandemic hit, reproductive health advocates pushed for this restriction to be lifted in the COVID context, when going to a health clinic for care created health risk and posed an undue burden on the right to receive abortion care. The FDA temporarily relaxed the restriction, making way for models like Hey Jane to come in and help deliver mifepristone to patients at home. The Trump administration fought the change all the way to the Supreme Court, which ultimately reinstated the requirements but made clear that this was a matter for the FDA, not the courts, to decide. Under the Biden administration, the FDA decided to stop enforcing the provision for the duration of the pandemic, and announced a long-overdue review of the FDA regulation, which is expected to lead to a permanent shift that would facilitate the delivery of abortion pills by mail.


While Hey Jane still has to contend with a massive number of state-level policies and regulations around both abortion access and the use of telemedicine, the regulatory shifts over the past year have opened the door for telemedicine abortion. While Hey Jane is limited to states with favorable abortion policy landscapes, this is still a huge win for access – as I heard from patients themselves, the barriers extend beyond policy, and even people in states like New York struggle to access fast, affordable, convenient, non-judgmental care.

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