Abortion access expands with online prescriptions in Michigan. Some fear risks

• After years of wrangling, Planned Parenthood of Michigan patients can access medical abortions via telehealth
• Independent clinics say they are poised to do the same
• Proposal 3 and other changes cleared the way for the changes

Access to abortion in Michigan is widening, after the state’s largest provider, Planned Parenthood, this year began to prescribe the so-called “abortion pill” through telehealth smartphone or online consultations.

Now, several independent clinics may soon follow suit, mailing the pills to patients after virtual appointments.

“We want to make sure all of our legal ducks are in a row,” said Tanya Little, vice president of Summit Women’s Centers in Detroit.

Related:

• Abortion pill’ under legal scrutiny; what it means in Michigan.
• New Planned Parenthood CEO: We have abortion options for post-Roe Michigan

Renee Chelian, founder of Northland Family Planning Centers, which operates three metro Detroit said the clinic will start to prescribe the abortion pill via telehealth soon after “multiple conversations with our attorneys and others.”

Often known as “the abortion pill,” medical abortions involve a combination of pills that soften the cervical lining and end pregnancy. They comprise half of all abortions nationwide and in Michigan. In 2021, 15,367 of the state’s 30,074 abortions were medical abortions, according to state data.

Abortion supporters and opponents agree that expanding telehealth prescription services would vastly increase access in a state where large swaths of land are many miles from a clinic.

Planned Parenthood operates 14 of Michigan’s approximately two-dozen providers, and most are in urban areas. In the Upper Peninsula, the sole provider is in Marquette County, while the only clinics in the northern Lower Peninsula are in Grand Traverse and Emmet counties.

“Dispensing the abortion pill through pharmacies after website consultations will allow telemedicine abortions to skyrocket due to the ability of a woman to do a telemedicine visit from her home and pick up the abortion pill at her (drug store),” said Genevieve Marnon, legislative director for Right to Life Michigan.

The increase in access follows years of uncertainty, legal challenges, federal policy shifts and Michigan voters’ approval last fall of Proposal 3, which enshrined reproductive rights into the state constitution.

In late 2018, then-Gov. Rick Snyder vetoed a plan to make permanent a temporary ban on doctors prescribing abortion-inducing drugs through webcams or other forms of telemedicine.

The federal government, under former President Donald Trump, also banned the practice, leading to a lawsuit. The Food and Drug Administration reversed course in 2021 under the Biden administration.

Planned Parenthood of Michigan last May began offering “direct-to-patient” medication abortion after a telehealth visit, but suspended the program a month later after the U.S. Supreme Court overturned Roe v. Wade, which had provided a national right to abortion for nearly 50 years. The group resumed the care again in January.

The COVID pandemic increased both telehealth services and acceptance in other areas of medicine. 

But some abortion providers were reluctant to roll out services because of the legal wrangling, said Jenny Sheehan, who leads telehealth efforts at the Washington D.C.-based National Abortion Federation, which supports independent abortion clinics.

“People are alternatively really motivated to integrate some type of telehealth and really hesitant to do anything new,” she said.

The National Abortion Federation has developed an abortion provider-specific telehealth platform, called tansy, to provide direct-to-patient conversations between providers and patients and put necessary consent forms in one place. 

The platform, like other telehealth services, asks for medical histories, too, but with a focus on reproductive health, Sheehand said.

About a dozen providers in other states, some with multiple locations, now use the services she said, adding that the National Abortion Federation is working with at least three Michigan providers now.

Vicki Moore, who operates the Women’s Center of Flint and Saginaw, told Bridge Michigan she expects to begin using telemedicine to provide medical abortion soon as well.

“It would be a game changer,” Dr. Zoe Russell said last week.

She spoke to Bridge after finishing providing abortion care to her last patient at Scotsdale Women’s Center clinic in Detroit. 

The schedule had been full that day, but it was 3 p.m.

“I could go home right now and do patients at home because people call (and need) an abortion, but we're full until next Thursday or something. So now they're waiting because they have to physically come in. Even coming into the office has barriers,” she said.

Some people rely on unreliable bus lines, for example. 

“If you could (get a prescription for the abortion pill) from the comfort of your home, it would make the process a little easier for the patient and for us.”

The tansy platform is specially tailored to abortion care, focusing on questions about reproductive health, she and Sheehand said.

Russell acknowledged some apprehensions, including that some patients could be ordered the pill without having an ultrasound or after miscalculating the age of the fetus.

Even so, she said, if doctors have any concerns about the patient being able to effectively and safely use the pill, or if they feel patients are uncertain about their pregnancy, they can still require an in-person visit.

Marnon of Right to Life Michigan, said she worries that increased access through telehealth could lead to more health complications.

Planned Parenthood of Michigan CEO Paula Thornton Greear said virtual abortion services will increase health equity, cutting down the need for some patients for transportation, child care and even overnight accommodations.

“It's about getting care to people in a way that works best for them,” she said. 

Telehealth is especially important, she said, for those with disabilities, who can’t access transportation, who can’t easily leave jobs during clinic hours, who have small children at home without child care, or live in remote or rural locations.