Anti-abortion advocates also are embracing abortion pill reversal, a controversial medical approach in which a woman who has changed her mind after taking the first pill in a medication abortion is given the hormone progesterone to reverse the pill's effects.
"We've been working with our state affiliates to stop (pill-based abortion), prevent this, protect the babies and mothers any way we can, whether it is preventing telemedicine from being used for chemical (pill-based) abortions or making sure that women can reverse the abortion if they act quickly enough," said Tobias.
"Certainly that's been something we've been focusing on, and we will continue to do so."
Abortion via telemedicine has been available in the U.S. since 2008, when the first formal program began in Iowa. A patient in one clinic confers, via video conference, with a doctor in another clinic and then receives abortion pills. This satisfies a federal requirement that the doctor "dispense" mifepristone to the patient in a clinic, office or hospital. The patient takes a mifepristone pill, which blocks the hormone progesterone, either at the clinic or at home. She then takes several misoprostol pills at home, causing uterine contractions and miscarriage.
But clinic-to-clinic telemedicine has limitations. The woman still has to get to a clinic, and the median distance to an abortion clinic is 180 miles or more in three states (North Dakota, South Dakota and Wyoming), as well as in large portions of states such as Texas, Alaska, Kansas and Nebraska, according to a 2017 study in The Lancet Public Health, which found the number of abortion clinics declined 6 percent from 2011 to 2014.
Gynuity Senior Medical Associate Dr. Elizabeth Raymond points to the dramatic example of Hawaii, where only two of the five most populous islands have abortion clinics.
Until recently, that meant that if a woman on another island wanted an abortion, she had to fly to Maui or Oahu, said Raymond.
But under the Gynuity study, a woman living on another island can get an ultrasound and bloodwork close to home, then video chat with a doctor on Oahu. The pills arrive by mail, no plane flight required.
"We do think it's a big deal to be able to do this, and it should be available, just as a regular, routine practice," Raymond said.
Maine Family Planning, where the Gynuity study has been operating since September, reports that a handful of patients there have received abortions at home via telemedicine, including a pregnant teenager.