PRH conducted a survey of its Leadership Training Academy (LTA) alumni to gain a better understanding of providers’ current provision of medication abortion care, their use of telehealth, what barriers exist (if any), and what resources are needed to ensure continued access to medication abortion care and the use of telehealth. Importantly, this survey was conducted prior to the Food and Drug Administration (FDA) removing some of the existing Risk, Evaluation, and Mitigation Strategies (REMS) requirements for mifepristone. However, other barriers remain. PRH believes the following information and recommendations collected from our LTA network is useful to partners and allies to support provision of medication abortion care and continue implementation and use of telehealth.
Read the high level findings below or our fact sheet covering the survey, methods, and findings here.
TOP LINES
Respondents that provide abortion care identified the following factors as positive influences on their ability to provide medication abortion care (top three):
- Supportive employer/institution
- Commitment to the work
- Protective state/federal laws
Other factors identified included: supportive staff, additional training, access to technology, and high demand/local need
Respondents that DO NOT provide abortion care identified the following barriers preventing them from doing so (top three):
- Unsupportive employer/institution
- Restrictive state law
- Hostile political/legal climate
Respondents identified the following additional resources needed in order to provide medication abortion care (in order from most popular response to least):
- Removal of restrictive laws and regulations
- Employer/institutional approval and policy change
- Removal of coverage/reimbursement restrictions
- Additional training/guidance on providing medication abortion in different practice settings
- Additional support staff
- Employment contract negotiation and legal support
Respondents identified the following changes to abortion care made during the COVID-19 pandemic that they feel SHOULD remain permanent (top three):
- Providing follow-up care via telehealth
- Providing a range of options for receiving care via telehealth (e.g., telehealth for consultation, follow-up, etc.)
- Removal of REMS requirements
Respondents identified the following changes to abortion care made during the COVID-19 pandemic that they feel SHOULD NOT remain permanent (top three):
- Limited family, friends, doula, community supports in clinics for patients
- Delays in care/decreased availability
- Telehealth intake visits (inefficient in some clinics)
Other challenges noted: shortage of trained providers; reimbursement requirements/rates; trouble getting mifepristone added to the formularies in hospitals/medical systems; medical licensure issues for providing telehealth services.
The majority of respondents felt that telehealth had enabled them to care for communities or individuals they otherwise would not have been able to care for.
Many providers named they were able to increase care to patients in rural areas, those who were out of state and unable to get care in their communities, for young people, for LGBTQ+ people, particularly trans folks, and those with transportation or childcare challenges.
Some who did not feel telehealth had enabled them to increase care expressed that access to internet/broadband was a barrier for many of their patients. They also expressed disappointment that it had not increased access for immigrant communities.