Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Mar 3, 2023
Date Accepted: Sep 26, 2023
The role of telehealth in promoting equitable abortion access in the United States: a spatial analysis
ABSTRACT
Background:
Even preceding the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision, patients in the United States faced exceptional barriers to reaching abortion providers, and abortion access was highly unequal. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times are increasing. Direct-to-patient telehealth for abortion care was introduced in the United States in 2020 and since then has expanded to many states, however, the role of telehealth abortion care in addressing geographic barriers to and inequities in abortion access remains unclear.
Objective:
We sought to examine the amount of travel patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access.
Methods:
Using geospatial analyses and data from patients in 31 states and Washington D.C., we documented the travel to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, prior to the Dobbs decision. We examined whether telehealth made it possible for patients to have an abortion in a timely manner and whether this varied by patient characteristics and travel averted.
Results:
The 6,027 patients averted a median of 10 miles and 25 minutes of round-trip driving, and 1 hour and 25 minutes of round-trip public transit time. Across the sample, patients averted a total of 162,663 driving miles and 4,195 driving hours, and 11,720 hours of public transit time. Among 1,586 patients surveyed, 43% reported that telehealth made it possible to obtain timely abortion care. Telehealth was more likely to make it possible to have a timely abortion for younger patients; rural patients; those experiencing food insecurity; patients of color; and those who averted over 100 driving miles.
Conclusions:
Telehealth is a powerful tool to reduce abortion-related travel in states where abortion remains legally accessible, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity.
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Copyright
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