What the Supreme Court's abortion pill case could mean for California

"This is bewildering, surprising and unexpected — we expected the numbers to drop," said Upadhyay. "There's a lot of unmet need being met through telehealth."

'Half the patients I see are sitting in their car'

The meteoric rise of medication abortion is part of the reason antiabortion activists have gone to such pains to get rid of it, many say.

"Telehealth abortion is worrisome to that side because they know that it is safe and it is effective and people can end pregnancies on their own," said Michele Goodwin, a law professor at UC Irvine and an expert on reproductive justice. "That's threatening to them."

Medication abortion using mifepriestone was already cheaper, faster and easier to access than vacuum aspiration and other in-clinic procedures when telehealth became available under emergency pandemic rules in 2020.

But it became radically more accessible and less expensive in 2021, as virtual providers including Hey Jane, Abortion on Demand and 145 Abortion Telemedicine established themselves alongside brick-and-mortar clinics under the FDA's new guidance.

And more clinicians felt called to offer it in 2022, as state bans pushed abortion seekers to neighboring states, stretching wait times at in-person clinics in Colorado, Illinois and Kansas, where an in-clinic appointment can take weeks to secure.

"Even before the Dobbs decision, I asked myself, what can I do?" said Dr. Stephanie Colantonio, a Los Angeles-based pediatrician who began providing care in 2021. "It was really meaningful to me that I would be able to offer this to people."

California has also moved to make care more accessible, though barriers remain. Medi-Cal covers about half of all abortions in the state — almost the same as the proportion of births it pays for — but billing for telehealth is still novel, and few providers can do it.

"California only recently updated the law to cover telehealth for abortion last year," said Upadhyay. "For most [Medi-Cal] patients, they have to decide, do I want free abortion or do I want to pay and get telehealth?"

...continued

swipe to next page