Telehealth vs In-Clinic Medication Abortion Provision

In states that restrict abortion provision, residents rely on telehealth medication abortion (teleMAB) or travel out of state for in-clinic care; however, little is known about how patients using these modalities differ.

To compare characteristics of Kansas and Texas residents receiving teleMAB vs in-clinic medication abortion and to assess geographic and socioeconomic factors associated with modality of care.

This retrospective cross-sectional analysis used electronic medical record data for patients residing in Kansas or Texas who received medication abortion care from a teleMAB service or from an abortion facility in Kansas from February 1 to June 30, 2024. Patients younger than 18 years were excluded because only the telehealth site served this age group.

Patient sociodemographic characteristics (age, race and ethnicity, and number of children), gestational age, and county-level distance to the nearest abortion facility, social vulnerability, and rural-urban designation.

The main outcome was receipt of teleMAB vs in-clinic care. Differences between patients who received teleMAB vs in-clinic care were assessed using χ2 and t tests for bivariate variables and multivariable logistic regression for adjusted comparisons.

The teleMAB service served 12 823 patients (Texas: n = 12 552; Kansas: n = 271); the clinic served 725 patients (Texas: n = 587; Kansas: n = 138). Mean (SD) age was 26 (6) years for Kansas residents and 27 (6) years for Texas residents. In both states, more telehealth patients self-identified as Hispanic, Latino, Latina, or Latine (Texas: 3739 of 12 552 [32%]; Kansas: 48 of 271 [18%]) than in-clinic patients (Texas: 14 of 587 [3%]; Kansas: 8 of 138 [7%]) (P < .001). This difference remained among Texas residents after adjustment. In both states, compared with in-clinic patients, telehealth patients were more likely to be at less than 6 weeks' gestation (Texas: 7648 of 12 552 [61%] vs 155 of 587 [27%]; Kansas: 159 of 271 [59%] vs 45 of 138 [33%]; P < .001) and to have no children (Texas: 5545 of 12 552 [44%] vs 42 of 587 [7%]; Kansas: 137 of 271 [51%] vs 5 of 138 [4%]; P < .001). In Texas, patients who lived farthest from in-clinic care were more likely to receive telehealth than those who lived shorter distances (average marginal effect, 0.003; 95% CI, 0.002-0.004).

In this cross-sectional study of patients who used medication abortion, teleMAB patients more often had no children, were living farther from an abortion facility, and represented populations facing structural racism and long-documented barriers to abortion care compared with in-clinic patients, particularly in abortion-restrictive states. A higher number of patients at lower gestational age received telehealth than in-clinic services, suggesting more convenient and timely care.