What is Giving Compass?
We connect donors to learning resources and ways to support community-led solutions. Learn more about us.
This op-ed by Julia Rohrer, Shruthi Jayaram, and Laura McEown was previously published on September 21, 2022 in the Chronicle of Philanthropy. Reprinted with permission.
The Supreme Court’s ruling to overturn Roe v. Wade has left millions of dismayed and angry Americans feeling as if they were hurtled back 50 years, before abortion became legal. But there is at least one difference in 2022 that offers hope. Well, two, to be exact: mifepristone and misoprostol, also known as the abortion pills.
Abortion pills account for more than half of abortion procedures in the United States. Clinics offer them as an alternative to surgical abortions up to 10 weeks into a pregnancy, depending on patient circumstances. They can also be taken at home or anywhere else following an online or phone consultation with a doctor, removing the need to travel to a clinic.
With telemedicine start-ups and nonprofits shipping pills by mail and helping patients manage care at home, these so-called fully remote medication abortions have become an increasingly viable option and are critical to preserving access to legal care in the post-Roe world.
But to fulfill their promise, several challenges to obtaining and using abortion pills must first be addressed, including legal obstacles confronting both abortion providers and patients and a lack of awareness and equitable access to fully remote medication abortions. If not expanded thoughtfully and in collaboration with in-person clinics, the growth of this option can also threaten the financial viability of in-clinic abortion care and end up reducing overall access and choice.
This is where philanthropic support comes in. Well-timed, strategic investment across the reproductive-care landscape can extend the reach of fully remote medication abortion and begin to pave a path toward expanded access and greater equity. Here are three concrete actions grant makers can take:
Protect providers and patients from legal challenges. State abortion laws are in flux, and some states are pursuing aggressive legal strategies to criminalize both patients and abortion providers, including prosecuting doctors who care for patients traveling from states where the procedure is banned. Faced with the threat of criminal charges, losing their licenses, or putting their patients in legal jeopardy, providers, as well as abortion-funding organizations, face impossible choices about where to draw the line on legal risk. This includes, for example, whether to require patients to physically take the abortion pills only in states where abortion is legal.
The uncertain and punitive legal environment is a particular challenge for telemedicine abortion providers, who are navigating rapidly changing and unclear regulations and grappling with a unique set of questions about cross-state care given the virtual nature of their services. Many, as a result, are cautious about expanding into new states or providing care to traveling patients.
The most direct way grant makers can help is by funding legal support for telemedicine providers, patients, and patient-support organizations that assist patients who need to travel to other states for care. This could include targeted funding to nonprofit legal organizations such as the Center for Reproductive Rights, the ACLU, and If/When/How to track changing laws, interpret their impact on telemedicine abortion, and provide legal support as needed.
Foundations could also play a convening role by bringing together policy makers and telemedicine providers in states where abortion is protected to share policy and legal strategies on remote care across states. This could expand on the work of organizations such as the Reproductive Freedom Leadership Council, a network of state legislators that champions reproductive rights.
Raise awareness. As few as 1 in 4 Americans are aware that they can have an abortion by taking medication. And even those who have heard of the abortion pills may not know how to obtain and use them legally and safely through online sources. This limited awareness, combined with legal and access challenges, could result in less than 20 percent of patients opting for fully remote medication abortion in the next five years, according to projections from our organization, Dalberg.
Nonprofits such as Plan C, I Need An A, and Abortion Finder publish information about how to find and use the pills, but could expand their reach with more philanthropic dollars, including offering information in different languages and running targeted outreach to underserved communities. Given growing concerns that online data can be traced and weaponized against those seeking and providing abortions, donors could also help these groups strengthen their online security by, for example, using encrypted messaging services, such as Signal, so they can share information with patients without leaving a digital footprint.
Ensure equitable access. Several factors beyond a lack of awareness pose additional barriers to remote care, all of which disproportionately affect marginalized communities. These include trust, safety, language, and price.
Given systemic bias and historical injustices, people of color have higher levels of mistrust in the medical system, which may inhibit them from seeking abortions online. Unhoused patients or those facing domestic violence may not have a place where they can safely receive and use the pills. Support from providers is often available only in English, limiting access for non-English speakers, including some immigrants. And while remote care is often cheaper than abortions performed in clinics, telemedicine services are less likely to offer financial support such as Medicaid coverage or connections to abortion funds that make care affordable to the poorest patients.
To prove their business model, many for-profit telehealth start-ups focus first on easier-to-reach patients in more affluent communities, while nonprofit providers often lack the resources and expertise to tailor their services to patients who have long been marginalized. Grant makers can help telemedicine providers design fully remote abortion medication options that make equity a priority. This could include the creation of guidelines on how to provide culturally competent, trauma-informed care online, as well as legal and regulatory research about how to work with Medicaid to fund remote abortion services.
Grant makers could also support telemedicine providers and abortion funds to create more streamlined, user-friendly, online processes for all patients to connect to financial and logistical support for remote medication abortions. This could build on the work of organizations such as the National Network of Abortion Funds, which connects patients to abortion funds across the country.
Philanthropic investments in fully remote medication abortion should complement sustained assistance for in-person clinics, while offering an alternate option for the hundreds of thousands of people who seek abortions every year. As long-term legal battles over reproductive rights play out across the country, grant makers shouldn’t lose sight of the power of two little pills to provide people with the care they need.
Julia Rohrer is an associate partner at Dalberg specializing in access to healthcare, and was previously a fellow at Hey Jane, a fully remote abortion clinic.
Shruthi Jayaram is an associate partner in Dalberg and leads its global gender equity and women’s rights work.
Laura McEown is a project manager at Dalberg, specializing in gender and health equity.