Telemedicine reproductive care connects options in Oregon
SALEM — Telemedicine has provided a new avenue for abortion access for Oregonians, utilized by about 50 patients in its first year.
Planned Parenthood Columbia Willamette is part of a trial by Gynuity Health Projects that is allowing some patients in Oregon, Washington and several other states to obtain abortion medication via telemedicine.
The sparse use of the option might be because many women don't know the service is available. Women seeking an abortion can do so in the first 10 weeks of pregnancy by taking two pills, rather than a surgical abortion. The U.S. Food and Drug Administration tightly regulates the first of the two medications, mifepristone. Patients can only get mifepristone by physically going to a certified provider at a clinic or hospital.
Participants in this research study, instead, can get necessary tests locally, consult with a Planned Parenthood clinician via videoconference, and then receive both medications by mail.
Gynuity Health Projects is a New York research nonprofit focusing on reproductive and maternal health care.
Limited clinic access
Abortion providers are far sparser than pharmacies, particularly in rural areas. As of 2014, there were 27 non-specialized facilities in Oregon that provided abortion services, and 15 specialized abortion clinics, according to a 2017 paper published in the journal Perspectives on Sexual and Reproductive Health.
At that time, about 30 percent of Oregon women lived in counties without a specialized abortion clinic. Oregon's easternmost Planned Parenthood clinic is in Bend. Some patients in Eastern Oregon travel to Washington or Idaho if clinics in those states are closer.
The new telemedicine process has several steps. When a patient calls Planned Parenthood Columbia Willamette seeking an abortion, the call center asks if they want to use the telemedicine option, and connects the patient with the organization's research coordinator, who explains the process.
If the patient is still interested, the coordinator helps them set up an ultrasound and blood tests through a local medical provider.
After results come through, the patient has a videoconference with a clinician who discusses the results and prescribes the two abortion medications, if appropriate. Patients seeking a medication abortion don't necessarily need to see a clinician in person, said Dr. Paula Bednarek, medical director for Planned Parenthood Columbia Willamette.
"You need an ultrasound and blood work somewhere, but you don't have to go far away for those, necessarily," Bednarek said. "And then the rest of the visit is really about counseling and education, and making sure everybody feels prepared, and then getting the medications to the patient."
Planned Parenthood then mails the medications. Once the patient takes the medications, Planned Parenthood is available around the clock to counsel them. Patients have a blood test, pregnancy test or ultrasound later to check that the pregnancy has been terminated.
But not many people know about the telemedicine option, Bednarek said.
"Patients don't know that it's available," Bednarek said. "And by the time they call our office, they've already figured out how to get themselves into a health center, and so they've spent a couple of weeks figuring that piece out, and they didn't realize this was an option."
Is it safe?
Liberty Pike, communications director for Oregon Right to Life, said that group has concerns about the safety of the first pill, mifepristone.
"This drug has very serious potential side effects," Pike said, "And telemedicine is going to bring it to women who are very far away from major hospitals that can provide the level of care women would need to overcome the very serious side effects that this drug has."
The FDA reviews "adverse events," which include hospitalizations, blood loss requiring a transfusion, and infections in women who took the medication to terminate a pregnancy.
There have been about 1,400 such adverse events reported to the FDA between November 2012 and December 2018. According to the FDA, 24 patients have died after taking mifepristone since the drug was approved in the U.S. in September 2000.
But the agency says that "the adverse events cannot with certainty be causally attributed to mifepristone."
"There have been millions of medication abortions provided in the United States, and very, very rare concerns," said Bednarek.
And, according to reporting by The New Yorker, citing a 2017 article in the New England Journal of Medicine, women are 14 times more likely to die from pregnancy-related complications than from mifepristone.
The World Health Organization reported July 9 that both mifepristone and misoprostol were safe for patients to take without "close medical supervision." The global organization has considered both medications "essential" since 2005.
About 8,400 people received an abortion in Oregon last year, a figure that has been steadily declining during the past several years, according to the Oregon Health Authority. The same trend is happening nationally, with researchers pointing to the increased availability and affordability of birth control as one factor.
In 2016, Oregon became the first state to implement a law allowing patients to access the over-the-counter birth control. A similar idea generated buzz on Capitol Hill last month, when Sen. Ted Cruz, R-Texas offered to team up with Rep. Alexandria Ocasio-Cortez, D-N.Y., to introduce a similar bill.
Researchers also point to increased restrictions on abortion access in many states as another potential reason abortions are decreasing nationally.
As restrictions tighten, they are likely to face legal challenges. Abortion rights advocates worry the U.S. Supreme Court could roll back Roe v. Wade, the watershed 1973 case that determined women had a legal right to an abortion.
Oregon has no restrictions on abortion. Lawmakers have voted in recent years to expand access to reproductive health services, including abortions, for low-income women.
Oregon voters also have pushed back on attempts to limit abortion access.
In 2018, anti-abortion advocates promoted a ballot measure to prevent state money from being used to pay for abortion services. Nearly 65 percent of Oregon voters rejected the measure.
Meanwhile, at least one abortion rights group is preparing for their fight for Oregon's 2020 ballot.
In early July, EMILY'S List, a national group that backs pro-choice Democratic women for elected office, announced a major effort to pour $20 million into state legislative races across the country — including Oregon.
EMILY's List is not yet sure which Oregon districts it will focus on next year, said spokeswoman Ianthe Metzger. All state House and some state Senate races will be on the ballot.
"There are so many strong women lawmakers in Oregon who want to lead and EMILY's List is committed to their continued success and supporting them throughout their paths in public office," Metzger wrote in an email to the Oregon Capital Bureau. "That's why Oregon continues to be a priority for us and this is a big part of the focus of our expanded push in state legislatures."
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