Study shows that state-level policies restricting telemedicine and medication abortion will continue to impede abortion care provision
By: Ariel Volk, volk.90@osu.edu
May 10, 2021
CINCINNATI, Ohio – Medication abortion use in Ohio, Kentucky, and West Virginia did not significantly increase despite the temporary suspension of the U.S. Food and Drug Administration (FDA) in-person dispensing requirement of mifepristone during the COVID-19 pandemic, a new study from the Ohio Policy Evaluation Network (OPEN) reports.
The research, which was published in Contraception, examined the combined impact of federal, state, and institutional policies on medication abortion use at 14 abortion facilities in Ohio, Kentucky, and West Virginia between December 2019 and December 2020.
“Multiple decisions occurred at the federal level around the REMS on mifepristone during the pandemic,” says Kelsey Mello, the study’s lead author and a graduate student in Women’s, Gender and Sexuality Studies (WGSS) at the University of Cincinnati. “We wanted to see how these decisions affected abortion provision in states like Ohio, Kentucky, and West Virginia, which have restrictive policies on medication abortion.”
The REMS, or Risk Evaluation Mitigation Strategy, is an FDA program requiring that the medication abortion drug mifepristone be ordered, prescribed, and dispensed in a clinical setting by a certified provider. A federal court temporarily suspended the in-person dispensing requirement in July 2020 in response to the COVID-19 pandemic – a decision that was overturned in January 2021 by the U.S. Supreme Court. It was then reinstated by the FDA in April 2021 to allow for the distribution of mifepristone through the mail for the duration of the pandemic.
“The medication abortion drug mifepristone is extremely safe,” says Michelle McGowan, PhD, co-author of the study and Research Associate Professor of Pediatrics and WGSS at the University of Cincinnati. “Considerable research has demonstrated its safety, which undermines the necessity of the REMS on mifepristone.”
Despite the temporary lifting of the REMS on mifepristone in July 2020, there was not a significant increase in the percent of medication abortions in Ohio, Kentucky, and West Virginia.
These findings point to the importance of efforts to eliminate state-level regulations on abortion, according to McGowan.
“Patients in these states are unable to take advantage of the lifting of the REMS in-person dispensing requirement because state laws restrict the distribution of medication abortion,” she says.
Kentucky and West Virginia both banned telemedicine abortion in 2018, whereas Ohio law requires that the abortion-inducing drug be dispensed at a clinic by a physician. The OPEN study found that these restrictive telemedicine and medication abortion policies created additional obstacles for medication abortion provision during the COVID-19 pandemic.
People of color, people of a lower socioeconomic status, and people who live far from an abortion clinic are those most likely to be impacted by the restrictions on medication abortion in Ohio, Kentucky, and West Virginia, says Mello.
“The REMS is a barrier, but it is just one of several hindrances to the expansion of telemedicine abortion distribution across the United States,” she says. “There is a lot of work to be done at the state-level to ensure access to abortion care.”
Danielle Bessett of the University of Cincinnati and B. Jessie Hill of Case Western Reserve University also worked on the study. Researchers from The Ohio State University include Mikaela Smith, Payal Chakraborty, Katherine Rivlin, and Alison Norris.
About the Ohio Policy Evaluation Network
OPEN is a research collaborative that launched in 2018 to study how policy affects reproductive health and equity in Ohio and surrounding states. OPEN offers policymakers, healthcare providers, community-based organizations, and administrators the scientific evidence that helps them support patient autonomy, better serve their communities, and provide quality reproductive health care.