Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, CA, United States.
Center for Gender and Health Justice, Global Health Institute, University of California, Oakland, CA, United States.
J Med Internet Res. 2024 Aug 5;26:e50749. doi: 10.2196/50749.
Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women's Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021.
This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care.
We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic's policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits.
We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available.
Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available.
自多布斯诉杰克逊妇女健康组织最高法院裁决以来，远程医疗堕胎在美国维护堕胎服务方面发挥了至关重要的作用。然而，自 2021 年远程医疗堕胎在美国首次广泛普及以来，关于新的仅提供远程医疗服务的虚拟诊所堕胎提供者的情况知之甚少。
本研究旨在：(1)记录美国仅提供远程医疗服务的虚拟诊所堕胎护理的情况；(2)描述 2022 年 9 月多布斯裁决后和 2023 年 6 月之间虚拟诊所堕胎服务的存在情况变化；(3)确定可能导致虚拟诊所堕胎服务获取不平等的结构性因素。
我们通过审查网络搜索结果和堕胎目录，对 2022 年 9 月和 2023 年 6 月的虚拟堕胎诊所进行了重复的横断面研究，并描述了这两个时期之间虚拟诊所存在情况的变化。在 2023 年 6 月，我们还描述了每个虚拟诊所的政策，包括服务的州、费用、患者年龄限制、保险接受情况、可用的财务援助以及妊娠限制。
我们记录了 2022 年 9 月在 26 个州和华盛顿特区有 11 家提供远程医疗堕胎服务的虚拟诊所。到 2023 年 6 月，有 20 家虚拟诊所提供服务，分布在 27 个州和华盛顿特区。大多数(16 家)为未成年人提供服务，8 家提供妊娠 10 周内的服务，中位数费用为 259 美元。此外，有 2 家接受私人保险，有 1 家在有限的几个州接受 Medicaid。大多数(16 家)有某种形式的财务援助。
自多布斯裁决以来，虚拟诊所堕胎提供者大量涌现。我们记录了虚拟诊所提供远程医疗堕胎服务方面的不平等情况，包括排除未成年人的年龄限制、护理的妊娠限制，以及有限的保险和 Medicaid 接受情况。值得注意的是，在 11 个允许进行人流手术的州，并不允许虚拟诊所进行堕胎手术。
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