In April, the Biden administration reversed a Trump-era requirement that made it impossible for doctors to remotely prescribe mifepristone, one of two drugs commonly used in medication abortion. The decision made abortion care accessible in the same way other forms of health care have been since March 2020, when clinicians pivoted to telehealth during the pandemic. But while providers in Washington state and across the country have embraced the new delivery system of medication abortion by mail, advocates say access remains far from universal, including in the Pacific Northwest.
That might be surprising to some. With insurance and Medicaid coverage of abortion and state-level protections to keep abortion legal if Roe v. Wade is overturned, Washington bucks national trends toward anti-abortion legislation. But even here, 59% of counties, where 10% of Washington women live, have no abortion clinic, according to data from the Guttmacher Institute, a reproductive health policy organization.
Medication abortion by mail is a new way for people living in these underserved areas to access care. Patients in Washington can now seek treatment through digital clinics like Hey Jane or virtual consultations with established local brick-and-mortar clinics like Cedar River, which has locations in Seattle, Tacoma and Renton. Because medication abortions typically end pregnancy using mifepristone and a second drug, misoprostol, making the pills available by mail means patients can have abortions safely at home without traveling to a clinic. The nonsurgical option, which is effective in ending pregnancies of up to 10 weeks’ gestation, is becoming increasingly common, comprising 39% of all abortions in the United States in 2017, according to Guttmacher. During the COVID-19 pandemic, medication abortion had the added benefit of not requiring an in-office surgical procedure — and the exposure risks that came with it.
Ying Zhang, a family medicine physician based in Seattle, said that during the pandemic, many family planning providers around the country had been “putting in protocols to provide no-touch medication abortion where patients could get care without having to come on-site.”