As part of my project, I’ve been speaking with patients to understand their experiences finding and using Hey Jane, and what additional support they could have used throughout the process. I’ve also been looking at some initial data Hey Jane has been collecting from patients as part of a study with UCSF on telemedicine abortion care, to understand why patients choose telemedicine care in the first place and what that implies about how we can holistically support them.
Across interviews and surveys, I’ve consistently seen the same top reasons for choosing telemedicine abortion care, which shed some light on the broader landscape of abortion care, and telemedicine, in the US:
Comfort:
Patients are more comfortable managing their care at home, at prefer not to go into a clinic setting. Especially in the Covid context, where in-person care comes with additional risk and difficult, and especially for a stigmatized service like abortion, this speaks to the important role telemedicine can play in lowering barriers to care.
Privacy and confidentiality
Abortion is heavily stigmatized and not talked about in our society. While most patients are confident in their decision to have an abortion and glad that they did, some don’t feel comfortable speaking about it with their family or closest friends. Even speaking to a doctor live can be uncomfortable, so many patients prefer text.
Speed
Many patients who call local clinics to schedule their abortion face waiting times of two or more weeks to get an appointment. Even in states with liberal abortion policies like New York and Washington, clinics are overwhelmed and patients can’t get care quickly. Waiting for care is not only uncomfortable for the patient, but it can also put patients at risk of being ineligible for medication abortion (and requiring a more invasive, and more expensive, surgical procedure), or, in states with more restrictions, of passing the gestational limit.
Price
While Hey Jane doesn’t yet accept insurance, it’s still among the cheapest abortion options available, and provides financial assistance to patients who need it. Insurance coverage for abortion varies by state and by plan but is spotty, and many patients don’t want to use insurance for fear that their parents or employer will find out they had an abortion. Telemedicine models like Hey Jane keep care costs low by eliminating the need for tests and for brick and mortar buildings.
Taking time off / finding dependent care
Beyond the direct financial costs, accessing abortion care in a clinic setting can have indirect costs in terms of time and travel. Clinics can be hours away, and it can be difficult to navigate time off work and care for children, especially for a procedure you’re trying to keep a secret. At-home, mail-delivered care helps to limit some of these additional barriers.
Fear of judgment/discrimination
Even in liberal cities like New York City and Seattle, protestors line up outside Planned Parenthood. Patients have to push their way through protestors just to access basic healthcare services. Patients fear judgment from their primary care providers, too. With access to abortion so politicized, the privacy and comfort of telemedicine provides a lot of value.