Telehealth abortion requests doubled after Dobbs decision

Telehealth continues to grow as a trusted source of abortion care, especially among individuals living far from a clinic-based abortion clinic, according to a study published today (Oct. 20) in JAMA Network Open.

The analysis finds that requests for medication abortion through an asynchronous telehealth abortion service doubled in the months following the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization decision, particularly among people living farthest from in-person clinics.

Researchers examined more than 16,000 telehealth medication abortion requests submitted to the service between November 2021 and February 2023 across 18 states where telemedicine abortion was legal before and after Dobbs. The study assessed how distance to a brick-and-mortar abortion-care facility was related to demand for telehealth services. The analysis found that: 

• Telehealth medication abortion requests doubled in the eight months after the Dobbs decision. 
• Most patients who requested telehealth medication abortion services were under six weeks pregnant and had no children.
• Individuals living farthest from clinic-based abortion services consistently had the highest request rates: Before Dobbs, living 100 miles from a clinic was linked to a 13% higher request rate; after Dobbs, the increase remained significant, at 8%.

“These findings highlight how geography continues to shape abortion access even in states where abortion remains legal,” the authors noted. “When in-person options are far away, telemedicine becomes an essential pathway to timely care.”

This is especially true in rural areas, where local clinics and hospitals are threatened with closure, said the lead author Amy Willerford, a third-year medical student at the University of Washington School of Medicine. She holds a master’s degree in public health.

“There really isn’t a distance that telehealth can’t breach,” said senior author Anna Fiastro, a researcher in the Department of Family Medicine at the UW School of Medicine. The study underscores the growing importance of telehealth in ensuring access to early abortion care across the United States, she said.

As patients face increasing travel costs and logistical barriers, telehealth medication abortion has emerged as a key resource to overcome distance-related obstacles. 

Nevertheless, Willerford added, “We were surprised to see that even people who lived near clinics — sometimes just down the street — still used telehealth services.” This aligns with a growing body of research that suggests many prefer telehealth options for reproductive care even when clinic-based services are nearby.

Two other studies led by Fiastro backed up this research. The findings showed that the demand for telehealth medication abortion continues to grow, especially as clinics close. The first study, published in February in the American Journal of Public Health, showed that people who live farther from an abortion clinic are significantly more likely to turn to telehealth medication abortion. 

The second paper, published this fall in the journal Women’s Health Issues, showed a significant jump in telehealth medication abortion use, even in states where access was protected. Telehealth medication abortion requests increased by 74% after Dobbs. 

While patient demographics remained consistent before and after the ruling, reasons for seeking telehealth shifted: Privacy and comfort continued to rank highest, but concern over legal restrictions rose significantly post-Dobbs. The increase in demand was greatest, 88%, in states with fewer protective policies, compared with 68% in states with the strongest protections.

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