The abortion pill boom in the United States raises legal and ethical questions

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The Supreme Court ruling that struck down legal protections for abortion is transforming the delivery of reproductive health care in the United States, as telehealth start-ups fill treatment gaps caused by restrictions and bans.

Hey Jane and Choice, which release abortion pills to women following online consultations, have raised millions of dollars in venture capital funding to expand their services as demand surges following clinic closures abortion in several Republican-controlled states.

At least a dozen nonprofit telehealth providers, including Just The Pill and Aid Access, are also ramping up their operations. In some cases, the groups provide access to emergency contraceptive pills and other reproductive and sexual health services through online platforms.

Suppliers say the Supreme Court’s decision overturning Roe vs Wade has raised public awareness of abortion pills – a safe method of ending a pregnancy that was developed in the 1980s. pills directly to states that ban abortion, but women can use addresses of friends in states where abortion is legal or travel to receive the drugs.

The Biden administration and women’s rights activists have hailed the telehealth boom. They argue that it can help maintain access to abortion and relieve the financial and emotional stress that women face during unwanted pregnancies.

But it raises complex questions about the legality of services provided to women in states where abortion is banned, and whether this new generation of abortion providers can provide equitable access to their technology platforms and adequate standards of care. , while protecting user privacy.

“Everyone must learn how to use new technologies and what their limits are. Patients and clinicians can be overwhelmed with new responsibilities and new ways of doing things,” said Bonnie Kaplan, a medical informatics and bioethics expert at Yale University.

She said ethical issues have become more important now that telehealth is one of the few remaining ways to access abortion services in some US states. Better data protection and privacy rules are needed, along with updated ethical guidelines, Kaplan said.

Demand for medical abortion, which involves the use of two drugs, mifepristone and misoprostol, to terminate a pregnancy within the first 10 weeks, was increasing before the Supreme Court ruling and now accounts for more than half of all terminations pregnancy in the United States.

But demand has been supercharged by the Roe vs. Wade decision last month and a decision by federal regulators to allow telehealth providers to release pills to women’s homes without needing to see a doctor or pharmacist in person. of Covid-19.

“On Decision Day, we saw a 600% increase in visits to our website and since then we’ve seen about a 50% increase in the number of patients we serve,” said Cindy Adam, co-founder . and CEO of Choice, a San Francisco-based telehealth provider.

Just The Pill, a nonprofit provider, said it received 437 dating requests in the four weeks leading up to the Supreme Court’s decision and 801 requests in the following four weeks, an 83% increase from Requirement.

Choice charges women $289 for an online consultation and to send abortion pills to addresses in California, Colorado, Illinois and New Mexico, all of which are states where abortion and telehealth services are legal. .

Hey Jane, co-founded by former Uber executive Kiki Freedman, has raised $3.6 million and offers telehealth abortions in six states © Hey Jane

Adam predicts demand will continue to grow as more Republican-controlled states ban abortion and in-person clinic appointments in states where the procedure is legal become harder to secure in due to high demand, as more and more women are forced to travel for treatment.

The changing political climate against abortion was a big reason why Adam, a former nurse, and several other medical professionals founded Choice in 2020.

Last month, Choix raised $1 million in seed funding from Elevate Capital, a US venture capital fund, to accelerate its rollout, and is trying to raise another $2 million. It wants to expand its telehealth services — which include abortion, emergency contraception and treatments for genital herpes and other conditions — to 10 states where abortion is legal by the end of 2022.

Choice does not plan to release pills in states that ban telehealth abortion, but plans to launch a service to help women, in conjunction with other aid groups, who must travel from those states to receive abortion pills in neighboring jurisdictions where abortion is legal.

“These [state] the laws are designed to scare abortion or health care providers, but we feel we have every right to offer care coordination to our patients,” said Adam, who hopes the Congress will pass laws providing legal protection for telehealth providers.

The legal threat is real with at least 19 states requiring a clinician prescribing abortion pills to be present when they are taken, effectively banning telehealth services. Some states enforce abortion laws through “bounty hunter” clauses, which allow private citizens to sue anyone “aiding or abetting” an abortion, including pharmacists or doctors.

President Joe Biden signed an executive order this month to protect abortion access, but the lack of clarity surrounding conflicting federal and state laws remains a concern for providers. The American Pharmacists Association warned on Monday that the confusion “compromises patient care.”

Kiki Freedman, former Uber executive and co-founder of Hey Jane, which has raised $3.6 million and offers telehealth abortions in six states, said the company will comply with state laws to reduce the legal risk for patients and providers.

“While working at Uber, I certainly had a lot of exposure to regulatory complexity within a hyper-growth company,” said Freedman, who came up with the idea for Hey Jane in 2019 when the city’s last abortion clinic Missouri was closed.

But in an example of the complexity of operating in such a sensitive industry, Hey Jane was recently forced to remove certain elements from its website to protect user privacy. This followed a investigation by The Markup, a news agency, which has raised concerns about the potential disclosure of personal information contained in user reviews on its website and the use of software that tracks visitors’ online movement and facilitates advertisements on social media platforms.

“We’ve found the best way to reach people seeking safe abortion care through the channels they’re already on,” Freedman said. “That said, as the regulatory environment has become increasingly hostile, we have chosen to remove the Meta Pixel (the tracking software that allows it to advertise on Facebook and Instagram).

Health experts say the incident shows why data protection and privacy need to be tightened, given that women seeking abortions or clinicians providing services could be subject to lawsuits in some states.

Yale’s Kaplan said: “We have already seen people seeking abortion services being tracked and data about them sold by various websites. It’s happening with social media, and it’s happening with abortion telehealth services themselves.

“It certainly puts people at risk,” she said.


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