The ability to stay home during an ongoing global pandemic and still get health care is a privilege not everyone is afforded in the United States, and the digital divide separates those who can use the internet to access a range of health services, such as telemedicine, and those who cannot.
Despite gains in increasing access to broadband internet across the country, rural people continue to be left behind. Rural adults are less likely than suburban and urban adults to have in-home broadband, less likely to own traditional computers or tablets, and more likely to report major problems accessing high-speed internet.
A lack of regular access to broadband and technology makes it challenging for rural pregnant people to get abortion care via telemedicine, especially if in-person options are not feasible in their communities.
What’s more, rural hospitals often lack the infrastructure and health information technology necessary to adopt telehealth practices, and thus cannot offer the same level of telemedicine services as urban hospitals. Widespread telehealth availability is necessary for ensuring access to medical care in general, especially when care is otherwise out of reach. Without telehealth, people are often left with limited options.
Last April, about a year into the pandemic, the Food and Drug Administration lifted the rule that required mifepristone, the first pill in the two-drug regimen known as medication abortion, be dispensed in person at a health clinic or hospital by a doctor or other qualified medical professional. Lifting the rule has allowed patients in areas where telemedicine is available to have consultations with health-care providers (via the phone or internet) and receive the medication by mail, a way to promote physical distancing and continued access to abortion care during the pandemic.
In December, the FDA rescinded the rule permanently in a giant step forward for reproductive rights. But pregnant people living in areas with underdeveloped infrastructure are still largely shut out of telehealth services, forcing them to visit a qualifying medical facility or one of the few remaining abortion clinics in person to get a medication abortion—a potentially dangerous thing to do during the pandemic, not to mention cost- and time-prohibitive.
Access to abortion care is critical to ensuring reproductive justice, but structural inequalities outside of broadband access make it difficult, if not nearly impossible, for pregnant people in rural areas to obtain such basic services. Rural counties are less likely to have abortion providers, and on average, patients living in rural areas must travel greater distances for abortion care compared with women who live in cities or suburbs. Furthermore, rural areas are more likely to have a shortage of health-care providers and regularly face challenges with provider recruitment and retention, along with significant gaps in the availability of female clinicians, language-translation services, and culturally compassionate care.
Abortion is health care, and medication abortion is the future of abortion. Ensuring that folks living in rural areas have access to the telehealth infrastructure needed to obtain telemedicine abortion services is a necessary component of health and well-being, as well as a practical solution that could significantly reduce many other common barriers to abortion care: financial constraints, limited clinic availability, and mandatory waiting periods and counseling among them.
On paper, the FDA rule change would increase access to medication abortion for rural patients and pregnant people living in areas without providers nearby. But in practice, further steps must be taken to ensure that those who face heightened challenges accessing the telehealth options have the tools and technology necessary for the rule change’s intended benefits to be fully realized.
The FDA must now work with states and other federal agencies to improve telehealth infrastructure at both the patient and provider levels, provide subsidies and rebates for telehealth technology, and support initiatives dedicated to improving the women’s health workforce in rural areas.
At a time when the legal right to abortion and abortion access are in jeopardy, our lawmakers must protect rural patients and ensure equitable access to abortion services by enhancing the technology needed to promote safe abortion during the pandemic—and beyond.