Telehealth Medication Abortion: Comparing Advance-Provision Patients With Pregnant Patients

To compare characteristics of patients ordering abortion medications from a telehealth service for potential future use (advance provision) with characteristics of patients ordering medications to terminate a current pregnancy.

This cross-sectional study used electronic medical records from a U.S. clinician-supported asynchronous telehealth service to compare patient characteristics (including pregnancy status, age, number of children, race and ethnicity, social vulnerability, residential urbanicity, and reason for choosing telehealth) of individuals requesting abortion medications for future use with those of individuals ordering medications to terminate a current pregnancy in 25 U.S. states and the District of Columbia from August 2021 to March 2023. Comparisons were made with the Pearson χ 2 test and Wilcoxon rank-sum test ( P <.05).

During the 20-month period, 3,252 advance-provision patients and 21,317 pregnant patients received abortion medications from a clinician-supported telehealth service. Of advance-provision patients, 72.2% identified as White compared with 42.4% of pregnant patients ( P <.001). Mean ages for advance-provision patients and pregnant patients were 31 and 27 years, respectively ( P <.001). Fewer advance-provision patients (38.4%) resided in high-vulnerability counties compared with pregnant patients (48.7%) ( P <.001). The top reasons that patients chose advance provision included personal choice (81.0%) and concern for future legal restrictions (70.5%).

We observed substantial demand for advance provision of abortion medications through telehealth throughout the year and across geographies; notable surges in demand were associated with key political events. Advance-provision patients differ from pregnant patients and do not represent the demographics of those who traditionally have limited access to abortion care. Advance provision of abortion medications through telehealth warrants further study as restrictions on abortion persist and service models shift away from reliance on in-person access to clinicians.