“Hey, cluster of cells,” Etna resident Jessica Semler said when she found out she was pregnant. “This is so fantastic that you’re possible. I’m not ready yet — try in five years.” 

Semler was 25, recently resettled to Pittsburgh and temporarily unemployed. She wasn’t sure she could pay for parking, let alone a child. After taking her first dose of abortion pills on Jan. 5, 2013, Semler immediately felt relieved. “I had the most affirming experience I could have possibly had,” she said. The agency to choose her abortion method played a big part in that.

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Medication abortions, also known as medical abortions, eclipsed surgical ones in 2020. In December, the FDA approved telehealth abortions, allowing a safe, entirely-at-home abortion option. Tens of thousands of patients have gone online to consult a clinician, who has the pills mailed directly to the patient’s address. 

Telehealth medical abortion is often faster and cheaper than in-clinic options, which is especially critical as providers shoulder a swell of patients. The service is widely available in 20 states, but Pennsylvania is not one of them.

“People ask [about telehealth abortion] all the time. … We don’t offer it,” said Crystal Grabowski, a health care assistant at Planned Parenthood of Western Pennsylvania [PPWP]. “I know that we’re working on it. I hope it doesn’t take a long time.” She said PPWP has been discussing telehealth abortion for about a year. 

According to PPWP spokesperson Sara Dixon, staff shortages and state regulations have made it difficult for the clinic to expand services.

Jessica Semler had a medical abortion in 2013. (Photo by Heather Mull/PublicSource)

Allegheny Reproductive Health Center [ARHC], the only other abortion clinic in the region, is waiting for the Pennsylvania Department of Health to approve its proposed telehealth protocol, according to its CEO Dr. Sheila Ramgopal.

The department, in response to PublicSource’s inquiries, said it does not impose a specific bar to telehealth services, though they “must be offered in a manner that would comply with applicable state laws and regulations,” and the prescribing physician must be in a state-approved facility. Patients may need to go to a physical site to meet “regulatory requirements for pre-abortion clinical testing … but those results can be transmitted electronically,” the department spokesperson said in a statement.

Abortion in Pennsylvania is legal until the 24th week of pregnancy. Telehealth options would expand access as the state absorbs patients from Ohio and West Virginia. “Prior to Dobbs, we were seeing 30% of people from out of state,” Ramgopal said. “Now we’re at 60% out of state.” Wait times doubled from one week to two at ARHC as it schedules three times as many patients.

PPWP appointments are being booked a month in advance, and no slot is wasted. “We don’t get no-shows anymore. Everybody comes,” said Grabowski. It’s been a month since Roe fell, but to her, “it feels like a year.” 

In 2020, 51% of Pennsylvania abortions were medical as opposed to surgical — on par with the national average. As Pennsylvania clinics see in-patient surges, telehealth medication abortions could streamline abortion access. Yet no national organizations offering the service ship pills to Pennsylvania because of compounding state regulations. Neither clinic in Western Pennsylvania offers telehealth abortion, and the national online platform that does requires Pennsylvanians to drive out of state to pick up the pills. 

Medical abortions use two medications — mifepristone and misoprostol — to induce a miscarriage. The former blocks progesterone, stopping the pregnancy from progressing. The latter causes cramping and bleeding, terminating the pregnancy. Mifepristone is taken first, followed by a dose of four misoprostol pills 24 to 72 hours later. A second dose of misoprostol may be taken, particularly in later early-term pregnancies, to ensure the abortion is successful.

Ramgopal echoed other providers in saying that Pennsylvania’s regulations make it difficult for clinics to offer telehealth abortions in the state. “On a federal level, we could do it. Medically, we know it’s safe and it’s totally appropriate.” Practically, they said, ARHC is still waiting for the Department of Health’s greenlight.

PA telehealth abortion options

Planned Parenthood Keystone introduced telehealth abortions in Central and Northeastern Pennsylvania in May 2021. Most of their medical abortions are done in person, but telehealth abortions have been on the rise since Roe was overturned, according to spokesperson Samantha Bobila. The clinic is able to mail the pills to Western Pennsylvanians online but has not yet done so. 

Despite its sister site launching telehealth abortion months before the FDA decision, PPWP has not released an official timeline for offering the service. “My understanding is there’s no communication between the affiliates,” said Grabowski, speaking as an individual employee rather than a representative of Planned Parenthood. “I find that frustrating.”

Telehealth access for all kinds of care is in limbo because of abortion debates. “We should be approving telehealth permanently the way a lot of other states have done, and unfortunately, it just keeps getting caught up in abortion politics,” state Rep. Michael Schlossberg, D-Lehigh, explained in a June interview. Republican legislators are leading a persistent campaign to restrict telehealth abortion access, and legal uncertainty has made it difficult for providers to offer the service. 

“When you get a medical abortion, you don’t have any type of exam. … It’s less invasive, and that really matters to some people.” 

Abortion on Demand [AOD] is the largest U.S.-based online platform offering medication abortion access throughout the country. Its virtual Pennsylvania branch launched on June 27, according to AOD director of clinical operations Leah Coplon. 

AOD anticipated clinics would have longer wait times as neighboring states outlaw abortion and push patients into Pennsylvania. “Our goal was to offload some patients,” Coplon said, “who may be easily served by telehealth medication abortions.”

To do so, they have had to find a loophole — one that gets around the state’s regulations but requires patients to leave its borders. 

“We do not have a physical presence in Pennsylvania, which makes interpretation of [its] regulations difficult,” explained AOD founder and medical director Dr. Jamie Phifer. “Rather than challenging those rules, we have opted to take a more conservative path.” 

The state’s Targeted Regulations of Abortion Providers [TRAP] laws require physicians to meet burdensome requirements to keep their clinics open. Pennsylvania’s criteria are among the strictest in the country.

Keeping up with TRAP laws makes it harder for providers to maintain and expand abortion services, including telehealth options. 

Without an in-state location, it is difficult for AOD to operate the way it typically does. AOD will prescribe to Pennsylvanians only when they are in the state at the time of the consultation and can show a state-issued ID. Only Pennsylvanian AOD patients must leave the state to pick up their pills. In the 21 other states AOD serves, pills ship directly to the patient’s mailing address with discreet packaging. 

Pennsylvanian AOD patients must travel to a Maryland or New Jersey Fed-Ex to pick up their pills within one to two days of their appointment. The entire process takes between three to five days, faster than waiting for an in-person appointment.

Aid Access is the only other telehealth service currently offering FDA-approved abortion pills to Western Pennsylvania. Based in the Netherlands, European doctors prescribe the pills to patients in states with telehealth abortion restrictions. The prescription is filled at an Indian pharmacy, causing longer mail times than U.S.-based companies; delivery takes two to three weeks. 

Telehealth Abortion Access by State

The three telehealth abortion options in Pennsylvania are Abortion on Demand (which launched in the state on June 26), Planned Parenthood Keystone (which has not yet mailed pills to patients in Western PA) and Aid Access (which has a 14- to 21-day delivery time). Aid Access is the only platform offered in states with one option. (Map by Sophia Levin)

The three telehealth abortion options in Pennsylvania are Abortion on Demand (which launched in the state on June 26), Planned Parenthood Keystone (which has not yet mailed pills to patients in Western PA) and Aid Access (which has a 14- to 21-day delivery time). Aid Access is the only platform offered in states with one option. 

Benefits and barriers of telehealth 

Surgical abortions are typically the most expensive way to terminate pregnancies, followed by in-clinic medication abortions and then pills by mail. With fewer facility expenses, online platforms can charge less for their services. 

Telehealth abortions through Aid Access and AOD cost $110 and $289, respectively, both offering a sliding aid scale; patients pay what they can. Planned Parenthood Keystone offers the service for $500. 

The proportion of medical abortions has grown for a number of reasons. “Sometimes people want to experience symptoms at home,” Grabowski explained. “They want to experience the discomfort in the privacy of their own home. Also, let’s say that their partner couldn’t get off work to come with them.” The patient can wait to take the pills until a partner is available. (AHRC and PPWP currently require patients to take the first pill in front of a clinician.) 

Grabowski said some patients are afraid of the surgical procedure and exam that precedes it. “When you get a medical abortion, you don’t have any type of exam. … It’s less invasive, and that really matters to some people.” 

A 2017 study published in the Obstetrics & Gynecology journal found that telehealth medication abortions are not riskier than in-clinic ones. The FDA approved mifepristone use in 2000 for up to 10 weeks of pregnancy. In Pennsylvania, 83% of Pennsylvania abortions occur during that window. 

While telehealth medical abortions can be a more convenient and comfortable option for many pregnant people — because they bypass clinic protesters, are more affordable and offer more flexible scheduling — Coplon emphasized that AOD and online providers like it do not want to replace abortion clinics. Many on AOD’s staff have worked at independent clinics, which often offer services like birth control, cancer screenings and gender-affirming care.

Jessica Semlar. (Courtesy photo)

Coplon said abortion access is central to expansive reproductive healthcare access. “We’re very committed to making sure that actual, on-the-ground, bricks-and-mortar clinics exist as the backbone of abortion care in this country.”

Semler, the Etna resident who used abortion pills, described herself as “Miss Responsibility,” taking birth control and using condoms. She found out she was pregnant in 2013 after taking the requisite test to refill her birth control prescription. Despite supporting abortion rights, she felt shame when the test unexpectedly came back positive. 

“Being able to say, ‘OK, I am able to take all of this information and I will make the most educated choice for me,’ was empowering. It didn’t feel like, ‘OK, either I have this horrible pregnancy that I don’t want to have and have everyone looking at me for nine months and then give this baby away and then I’ll be traumatized,’” or have a surgery that scared her.

Semler chose a medical abortion nearly 10 years ago. If she becomes pregnant today, she says she’d choose it again, maybe via telehealth — if she could access it. 

Correction: Leah Coplon’s name was misspelled in an earlier version of this article.

Sophia Levin, a student at Carnegie Mellon University, is a freelance journalist and former PublicSource intern. She can be reached at sophia@publicsource.org .

This story was fact-checked by Emily Sauchelli.

The Jewish Healthcare Foundation has contributed funding to PublicSource’s healthcare reporting.

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Sophia Levin, a student at Carnegie Mellon University, is a freelance journalist and former PublicSource intern.