From the beginning of the human race, man has found a way to turn life-promoting technologies into tools of death. In the modern age we see this in the way that combining sonogram technology with lax abortion laws has made it easier to identify the sex of a child so that those without a Y chromosome can be killed before they’re born. Similarly, we are seeing during the pandemic how another medical technology—telemedicine—has also become a weapon against the unborn.
Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. Advancements in video technology combined with high-speed internet access have made it increasingly possible to deliver quality medical care even to remote areas.
While the technology has been around for years, it was not broadly adopted by either patients or medical providers. But the pandemic changed all that. As a recent study notes, “The COVID-19 pandemic forced rapid implementation of telemedicine into everyday practice. What once seemed like a lofty, futuristic goal became reality within the blink of an eye as various levels of telemedicine were globally transformed into practice.”
The shift from in-person to online has also affected abortion providers. As abortion clinics closed because of COVID, abortion providers began to offer telemedicine-only abortions.
From Surgical to Medical Abortions
To understand the rise of telemedicine-only abortions, you need to know about current abortion methods.
The two broad methods for legal abortions in the U.S. are medical and surgical. A surgical abortion is a method in which the child in utero is dismembered and body parts are removed by suction (aspiration) through a thin tube inserted into the uterus. It remains the most common form of abortion, with about 60 percent of all abortions being surgical.
The other method is a medical abortion, sometimes referred to as a medication abortion, chemical abortion, or pharmaceutical abortion. This method uses an abortifacient (a chemical or drug that causes embryonic death) to stimulate uterine contractions similar to miscarriage.
The most common method for chemical abortions approved by the U.S. Food and Drug Administration (FDA) involves he drugs Mifepristone and Misoprostol. Mifepristone (brand name Mifeprex) ends a pregnancy by blocking the hormone progesterone, which is needed to maintain a pregnancy. Because this hormone is blocked, the uterine lining begins to shed, removing the child (in the embryonic state) who was attached.
The second step, which occurs 24 to 48 hours later, requires taking Misoprostol, which causes the woman to expel the child and the uterine lining. In 2018, 38.6 percent of all abortions were medical abortions within eight weeks of pregnancy.
When Mifepristone was approved in 2000, the agency imposed significant restrictions, including the requirement that providers obtain a special certification to stock the drug and to give it out only in a clinic, doctor’s office, or hospital.
But while women are required to obtain Mifepristone only in these clinical settings, the FDA allows them to swallow the pill later at home without clinical supervision. This led the American College of Obstetricians and Gynecologists and other groups to file a lawsuit to force the FDA to allow abortifacients to be prescribed through telemedicine and mailed directly to pregnant women.
In response, the FDA said it will “exercise enforcement discretion” regarding the in-person dispensing requirement for Mifepristone, as long as the president’s declaration of a public health emergency for COVID-19 remains in place. This means the agency won’t enforce in-person prescribing requirements during the pandemic. It’s also becoming increasingly clear the pre-pandemic standards may not return.
Studies done during the pandemic have shown that medical abortions enabled by telemedicine are no more dangerous to the mother than obtaining the abortifacient directly from a clinic. This will be used by abortion activists as evidence that telemedicine-only abortions should be allowed even after the pandemic ends.
Today, 19 states prohibit telemedicine-only abortions by requiring the clinician who is providing a medication abortion to be present when the medication is administered. But the number of states that have such a prohibition is more likely to decrease than increase.
Prepare, But Don’t Despair
Telemedicine-only abortions are likely to be the future of abortion in America. Pro-life Christians need to be prepared for a shift in two directions.
First, the fight against abortion will increasingly shift from the national level to the state level. In many parts of the country, states have already become the primary focal point for implementing abortion restrictions. But this will become even more necessary when abortifacients can be prescribed and mailed across state lines.
Second, the primary focus of the pro-life movement will need to move from the clinic to the home, from the broadly political to the intimately personal. For almost 50 years, abortion clinics have served as a focal point for pro-life energies—physically (as a place to protest), rhetorically (as a location for sidewalk counseling), and politically (as an entity to place restrictions upon). Telemedicine allows abortion clinics to become less necessary for ending life in the womb. It may even increase the number of doctors willing to provide abortions when it requires only communicating via video screen and writing a prescription.
As abortions begin to occur more often in the home than in the clinic, our energy and attention will need to shift to finding those women who are most susceptible to having an early-term abortion. The role and importance of crisis pregnancy centers will likely expand considerably, as will other frontline pro-life services. Advocating against abortion will become more difficult, as we move from lobbying politicians to convincing pregnant women to choose life.
In the past, the pro-life cause has shown a remarkable ability to be flexible and innovative in facing the threats to life. That is likely to continue as the fight against abortion continues into the 21st century. But we need to prepare now for the future that is coming all too rapidly.