AUGUSTA — A first-of-its kind analysis by the Guttmacher Institute, the national research organization, recently found that one in five women in the United States would need to travel more than 40 miles to reach their nearest abortion clinic. Sizable minorities would have to travel much further – meaning more money shelled out for gas, more time taken off work, more expensive child care arrangements. The study underscored how distance continues to be a significant barrier to accessing abortion care, especially for economically disadvantaged women and those who live in rural areas.
“The ability to obtain needed reproductive health care services, including abortion, should not be determined by a woman’s ZIP code,” Guttmacher policy expert Megan Donovan said upon the report’s release.
Living in the most rural state in the nation, we agree. That’s why Maine Family Planning is part of a lawsuit challenging the state’s prohibition on nurse practitioners and nurse midwives providing abortions. Along with the American Civil Liberties Union and Planned Parenthood, we’re suing to overturn the unnecessary “physician-only” law, which poses a clear burden to patients by blocking qualified medical professionals from administering care that’s well within their scope of practice.
Until the physician-only law is off the books, we are chipping away at the distance barrier through our groundbreaking telehealth program, through which we have provided hundreds of Maine women with medication abortions via telemedicine. Here’s how it works: A patient schedules an appointment at one of our 18 clinics around the state. There, a nurse practitioner does a thorough history, lab testing and an ultrasound to ensure that the patient is medically eligible for the procedure.
The patient then meets via secure videoconference connection with a physician, who reviews all the health information and instructs the patient to begin the process with the first medication, mifepristone. The patient uses the second medication, misoprostol, at home.
Through this pioneering program, we have dramatically expanded abortion access to previously underserved communities stretching from Fort Kent to Skowhegan to Farmington to Belfast.
Indeed, the Guttmacher study showed Maine to be making gains in terms of how far women must travel for abortion care. According to Guttmacher, from 2011 to 2014, the median distance to an abortion provider for women in Aroostook County dropped by over 130 miles; in Washington County, the median distance fell by 126 miles, and in both Penobscot and Hancock counties, the decrease was over 120 miles.
Still, while telemedicine is revolutionary, it’s not without challenges. The physician-only law makes access to medication abortion unnecessarily onerous, requiring a telemedicine appointment with a physician even though a fully qualified clinician is available. It’s hard enough to align a patient’s schedule with that of a nurse practitioner, given that clinics are open only on certain days. Factor in the schedule of the doctors we work with – who have their own busy practices – and you have a logistical nightmare that can prevent people from accessing health care to which they have a legal right.
As Maine Family Planning nurse practitioner Julie Jenkins, a plaintiff in our suit, recently put it: “These harms are not hypotheticals.” Forcing women to jump through hoops can delay an abortion unnecessarily or make women needlessly travel for hours – if they can get the time off work, find a babysitter, and line up transportation, of course. We see it happen, and we will continue to unless things change.
Furthermore, telemedicine abortion is not for everyone. It is available only to women who are up to 10 weeks pregnant, and who are comfortable ending their pregnancy at home. Unshackling nurse practitioners and nurse midwives by overturning the physician-only law would open the possibility of providing in-clinic abortions at our 18 sites around Maine.
Last year’s landmark Supreme Court decision in Whole Woman’s Health v. Hellerstedt emphasized that states cannot burden patient access to abortion without proof of a valid medical justification. In the case of Maine’s physician-only law, that justification does not exist; in fact, experts agree that advanced practice clinicians are qualified to provide early abortion care, as they are already doing so in states across the country. We hope to join them soon.
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