November 20, 2018
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Maine Family Planning to offer telemedicine abortions

Women throughout Maine will have greater access to abortions under a reproductive health group’s plan to connect them with doctors over video conference.

Patients who typically must drive long distances for the procedure may now arrange for an abortion via telemedicine at one of Maine Family Planning’s 17 centers throughout the state, the organization announced Monday.

The move makes Maine one of just three states, along with Iowa and Minnesota, where abortion services through telemedicine are broadly available, according to Maine Family Planning.

The improved access contrasts starkly with much of the rest of the country, the group said. Restrictions on abortions have proliferated in other states, including Texas, which once permitted telemedicine abortions but has since banned them and passed additional legal limits leading to the closure of dozens of clinics.

The U.S. Supreme Court is scheduled to take up the Texas abortion law in a landmark case this spring.

Eighteen states ban abortions by telemedicine, largely by requiring a doctor to be in a patient’s physical presence during the procedure, according to the Guttmacher Institute, which advocates for access to abortion. Maine’s Legislature has never considered a ban on the practice.

Abortion opponents have called on states to prohibit abortion by telemedicine, saying women should undergo a physical exam by a doctor to ensure their safety and avoid complications.

The practice involves a type of “chemical abortion,” induced by taking medication, as opposed to a surgical procedure to end a pregnancy.

With the service expanding in Maine, women may now access abortion earlier in their pregnancies, closer to home and with less overall cost, Maine Family Planning said. Many women who desire an abortion, particularly in rural areas, struggle to find child care and must miss work, according to the group. They also must pay for travel in addition to the cost of the procedure, which the majority of women pay for out of pocket.

Prior to Monday’s announcement, nearly all women seeking an abortion in Maine had to visit one of just three clinics in the state: Maine Family Planning’s clinic in Augusta, Mabel Wadsworth Women’s Health Center in Bangor, or Planned Parenthood’s location in Portland.

“We are proud to be able to provide care to women throughout Maine by decreasing the barriers associated with the time and cost of traveling, and hope other states follow suit,” Leah Coplon, Maine Family Planning’s director of abortion services, said.

The organization piloted the new service during the past year in Aroostook and Washington counties, serving a “small number” of women, she said.

“The fact that our patients have been so satisfied and so grateful has really helped us see the need for this,” Coplon said.

Under Maine law, a medication abortion must be provided by a licensed physician, but the patient and doctor may be located in different places. Telemedicine is already used for a variety of medical treatments in Maine, including for psychiatric and neurological care.

Maine Family Planning will first screen patients by phone to ensure they’re a candidate for a medication abortion. The procedure is limited to women in the earlier stages of pregnancy, or no more than 70 days from the first day of the last menstrual period.

The patient then meets with a nurse practitioner at a Maine Family Planning clinic, who reviews her options and conducts a medical history, lab testing and ultrasound.

The practitioner also obtains the patient’s informed consent, the group said. If the patient is under 18, Maine law requires the involvement of a parent, counselor or another trusted adult.

If she’s found medically eligible, the patient meets with a physician over a secure videoconference connection. The doctor reviews her health records and discusses the procedure with her through a computer video screen, then prescribes the first of two medications, called Mifeprex, and directs her to take it while the physician watches.

The patient takes a second medication, misoprostol, at home, anywhere from six to 48 hours later. The drug’s side effects include heavy bleeding and cramping, nausea and upset stomach, Coplon said. Patients must agree to have a support person by their side as the pregnancy is terminated.

Patients also must return to the clinic a week later for a follow-up visit to ensure they’re no longer pregnant, the organization said. If the abortion was unsuccessful, patients must agree to end the pregnancy by another method that uses suction to empty the uterus.

Medication abortions are 95 percent to 98 percent effective and complications are rare, according to the National Abortion Federation.

The American College of Obstetricians and Gynecologists has voiced support for telemedicine abortions. After Iowa’s supreme court upheld the practice in June 2015, American College of Obstetricians and Gynecologists described it as a safe and effective way to end a pregnancy.

“Medication abortion care delivered through telemedicine can be particularly beneficial to rural women, whose reproductive health needs can be underserved due to geographic limitations,” the group said in a statement. “Without remote access to medication abortion, more women would have to delay or even forego abortion care.”

But opponents argue the practice is unsafe, citing cases in which women who took the medications suffered complications, including several deaths from sepsis in the U.S.

Maine Family Planning noted that no taxpayer dollars will fund its telemedicine abortion services. While some private insurers pay for the procedure, the state’s Medicaid program prohibits coverage for abortion.

Maine Family Planning, however, has joined with the American Civil Liberties Union and other women’s health groups to challenge that ban in court.

While telemedicine will expand access to women who wish to end their pregnancies, the organization doesn’t expect the service to significantly increase abortion rates in Maine.

In Iowa, abortions actually decreased after the introduction of telemedicine, according to a study that examined the two years before and two years after the law took effect. The research found patients in rural areas were more likely to obtain an abortion earlier, before 13 weeks of pregnancy, when the procedure is less risky and less expensive.

The telemedicine service will not be available at Maine Family Planning’s Belfast location, which provides no abortion care under a separate pilot program designed to integrate reproductive health services with primary care. The Belfast clinic will offer the service in the future, the organization said.

 


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