Webinar Organizers: Sara Moaddeli, Cecilia Eldridge, Eniola Owoyele, and Arezoo Kalan
The UCGHI Student Ambassadors organized a virtual webinar on May 3rd, 2022 open to all 10 University of California campuses as well as the general public. Our guest speaker Dr. Ushma Upadhyay discussed the current status of abortion in the United States, medication abortion, and her research on the safety and efficacy of telehealth abortion.
Webinar recording below:
Webinar overview below:
The Current Abortion Landscape in the United States
The day before the webinar, a draft of the Supreme Court decision on the case of Dobbs vs. Jackson Women’s Health was leaked. This decision is pivotal because it could overturn Roe v. Wade and eliminate the federal standard around abortion access. Dr. Upadhyay's webinar on abortion access was deeply relevant to the current political climate and sparked deep conversations with students about the future of abortion access in the United States.
What is at stake with the reversal of Roe v. Wade?
It would send the decision to states of whether abortion should be available or up until what pregnancy duration people should be able to access it
Nearly 25 states will most likely curtail access to abortion or ban abortion altogether
Abortion Access in Texas
Dr. Upadhyay then went on to discuss Texas’s Senate Bill 8. In October 2021, the Texas legislature passed this bill which bans abortion as early as 6 weeks. This bill is also a vigilante law that allows people to sue any abortion provider or anyone assisting someone in obtaining an abortion.
The effects of this law:
TxPEP is a research center at UT Austin that tracked the number of abortions over time between July and September. TxPEP found a ~50% decline in abortion.
45% of pregnant women have been going to Oklahoma to obtain an abortion and 27% have been going to New Mexico. The rest are going to other states. However, the governor of Oklahoma has recently signed an abortion ban. Thus, the percentage of people in Texas going to Oklahoma to get an abortion will decrease.
The law in Texas disproportionately affects BIPOC and undocumented people. Undocumented people face tremendous risk when traveling out of state. There are checkpoints at the border that place undocumented people at significant legal risk, forcing them into a difficult position where they must either attempt to travel at the risk of being deported from the United States or carry their unwanted pregnancies to term.
Abortion Access in the United States
While there are about 700 abortion providers in the United States, Dr. Upadhyay expanded on the reality of roughly 27 abortion deserts. An abortion desert is an area where people must travel over 100 miles to reach an abortion provider. This travel time adds barriers to care, as it requires more time off of work and arrangements for childcare as a majority of people seeking abortion are already parents.
Medication Abortion
“Medication abortion grew an interest for me because I saw so much potential in its ability to expand access to abortion and also normalize abortion care” - Dr. Ushma Upadhyay
Medication abortion involves two different drugs: mifepristone and misoprostol
Mifepristone → highly regulated by the FDA and stops a pregnancy from progressing
Misoprostol → induces uterine contractions that expend the content of the uterus out
Medical abortion has been available since 2000 and researched for nearly 40 years now. The abortion pill is approved for use around 10 weeks of gestation, though some clinics like Planned Parenthood offer this treatment up to 11 weeks of gestation. The pill can be used beyond the 1st trimester but becomes slightly less effective with increased gestational age.
“The proportion of medication abortion has been increasing over the years in the US. As of 2020, medication abortions account for the majority of all US abortions. It’s around 54%” - Dr. Ushma Upadhyay
COVID's Impact on Telehealth
During the COVID-19 pandemic, Dr. Upadhyay was able to model an analysis of telehealth usage for abortion access. In the model, it was assumed that telehealth would be available in all states. So,
“If we reduced travel distance to the lowest category, what will the impact be on abortion rates?”The analysis found that abortion rates would be much higher if travel distances were reduced by a lot – a lot meaning that people wouldn’t have to travel for an abortion.
Expanding on this idea of transportation as a social determinant of abortion access, Dr. Ushma explored the effectiveness and safety of medication abortion.
Data was collected by Medi-Cal which found that medication abortion was safe and effective 99.7% of the time. Despite the abortion pill’s strong safety record, the FDA places strict restrictions on mifepristone. Three major restrictions create a barrier to accessing the abortion pill:
Prescribers must be certified (The provider must be on a list of abortion providers, self-identify, and must be fine with being on this list).
Patients must sign a patient agreement form (This signals to the patient that this is a different kind of medication and that there are a lot of risks--this is not required for any other treatments for conditions like diabetes or heart disease)
Mifepristone must be dispensed to patients only in certain healthcare settings
Until recently, an in-clinic medication abortion would consist of a patient getting an ultrasound and then receiving the medications. Patients would take the medications at home and then complete a follow-up visit.
During this segment of the webinar, one of the students asked:
“What are the side effects with taking the medication abortion?"Side effects include bleeding and pain for a 24-48 hour period, and then spotting for up to 2 weeks. Medication abortion is a longer process compared to the procedural abortion which only consists of some spotting afterward.
In-person dispensing requirement suspended and then lifted during COVID
Dr. Ushma explained how this removal gave the CHAT study time to collect as much data as possible. In the era of COVID, virtual clinics were utilized and medications could be mailed to patients. All of these steps could be done from home. Dr. Ushma used an example of how one patient who was an Amazon truck driver was able to do her entire telehealth consult during her job. Dr. Ushma was impressed by how
“People are able to build access to care into their daily lives as a result of some service providers being asynchronous. It’s really innovative.”
Then, in December 2021, the FDA permanently removed the in-person dispensing requirement.
Another topic that was studied during the COVID-19 pandemic was the de-medicalization of medication abortion. Finding that providers were administering medication abortion without an in-person visit, Dr. Upadhyay conducted a study to analyze the outcomes of skipping the ultrasound and omitting any pre-abortion tests. The study was able to demonstrate:
Support for the safety of telehealth and provision of medication abortion without tests
Mandatory ultrasound requirements for medication abortion are not based on evidence
Patients can and should expect primary care providers to offer medication abortion (that means that someone in a clinic should be able to write a prescription and hand it over)
In April 2021, Choix, Hey Jane, and Abortion on Demand (virtual clinics that offer medication abortion in 22 states) collected 3,000 charts on their first 3,000 patients. They were able to recruit 3,000 participants and collected information on their experiences with the medication abortion. A published finding by Choix revealed that people’s experiences of these virtual clinics were very positive. Patients commented how they liked
“Not having to talk to anyone or feel judged by [their] decision.”
Who is Accessing Virtual Abortion Clinics?
Abortion patients are currently comprised of 40% white and 60% POC patients. Dr. Upadhyay comments how these services are mostly reaching people who have greater resources. One of her goals is to increase awareness about the availability of medication abortion and virtual clinics to address current disparities in access to care.
Overall, this webinar event was a valuable opportunity for students to clarify misconceptions around abortion access and care, and gather insights from Dr. Upadhyay about what a post Roe v. Wade society would look like and where students can make a difference.