Legal and Health Equity in Telehealth Abortion Care

Authored By: Allison Wong

Art By: Grace Liu

In the historic Roe v. Wade case, the Supreme Court ruled that “the right to liberty in the Constitution, which protects personal privacy, includes the right to decide whether to continue a pregnancy” [1]. This ruling expanded access to safe abortion care, promoting reproductive equity and addressing maternal health disparities. However, in 2022, the Supreme Court reversed this precedent in the Dobbs v. Jackson Women’s Health Organization, stripping federal protection for abortion rights. As a result, the Dobbs decision disproportionately impacts marginalized individuals, restricting access to equitable reproductive care [2].

Access to abortion services is especially vital for women from marginalized communities and lower socioeconomic backgrounds. In 2017, an international study conducted by the Guttmacher Institute concluded that “the most commonly reported reason for having an abortion was socioeconomic concerns” [3]. Similarly, the American Journal of Public Health published a study that concluded that “women seeking abortion reported economic hardships at the time of abortion seeking—half (51%) were living below 100% of the federal poverty level; 3 quarters (76%) reported not having enough money to cover housing, transportation, and food” [4]. This illustrates that these women are experiencing significant financial barriers that affect their ability to afford basic necessities, driving their decision to get an abortion.

Since the overturning of Roe v. Wade, new resources have been developed to help women navigate barriers to abortion care. For instance, telehealth has been commonly used to gain access to reproductive services and promote equity. Telehealth abortion service “involves a consultation followed by a prescription for mifepristone and misoprostol (medication abortion)” [5]. This helps partially alleviate the financial burden of abortion services by eliminating distance as a barrier to abortion access. For low-income patients, distance is especially a challenge given “the lower likelihood of car ownership, loss of wages from the time needed off work, transportation costs for gas or transit fare, as well as the cost of lodging and childcare” [6].

While there are undoubtedly legal consequences to telehealth abortion care, new legal measures have been enacted to help address these challenges. One measure, known as “Shield Laws”, allows patients to still have access to care, even if their state bans abortion. These laws effectively “protect clinicians based in states where abortion services (and other legally contested services) are permitted from facing legal ramifications for providing these services to patients in states where they aren’t permitted” [5]. This allows women to travel to states where abortion is legal and receive the care they need.

Another important aspect of navigating the regulation of telehealth abortion care is the Interstate Medical Licensure Compact (IMLC). The IMLC states that “all laws in a member state in conflict with the Compact are superseded to the extent of the conflict” [5]. This means that if abortion restrictions are not addressed in the compact between states, the restrictions in that specific state would still apply. Physicians who are protected under their state’s shield laws must not hold an IMLC license in a state with abortion bans/restrictions, travel to a state with abortion bans/restrictions, and provide telehealth from their state.

Ultimately, telehealth abortion services provide a critical lifeline for marginalized women, ensuring that care remains accessible even in the face of an abortion ban.

References:

1. Roe v. Wade. (n.d.). Center for Reproductive Rights. Retrieved February 27, 2025, from https://reproductiverights.org/roe-v-wade/

2. Harvey, S. M., Larson, A. E., & Warren, J. T. (2023). The dobbs decision—Exacerbating u. S. Health inequity. New England Journal of Medicine, 388(16), 1444–1447. https://doi.org/10.1056/NEJMp2216698

3. Unintended pregnancy and abortion in northern America | Guttmacher Institute. (2022, February 24). https://www.guttmacher.org/fact-sheet/unintended-pregnancy-and-abortion-northern-america

4. Foster, D. G., Biggs, M. A., Ralph, L., Gerdts, C., Roberts, S., & Glymour, M. M. (2018). Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States. American Journal of Public Health, 108(3), 407–413. https://doi.org/10.2105/AJPH.2017.304247

5. Upadhyay, U. D., & Grossman, D. (2019). Telemedicine for medication abortion. Contraception, 100(5), 351–353. https://doi.org/10.1016/j.contraception.2019.07.005

6. Shachar, C., Chary, S., & Carmen, M. (2025). Providing interstate telehealth abortion services to patients in restrictive states. New England Journal of Medicine, 392(5), 419–421. https://doi.org/10.1056/NEJMp2414283