Shout Your Abortion members hand out refreshments and information about abortion pills at their July 4 lemonade stand in front of the US Supreme Court. (Photo by Mary Ella Jourdak)
The US Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June overturned the federal right to an abortion formerly guaranteed by its 1973 Roe v. Wade decision, triggering state abortion restrictions and bans across the nation.
But advancements in medical technology have enabled pregnant people the opportunity to choose an at-home abortion. Abortion On Demand (AOD), a telemedicine abortion startup, seeks to overcome some of the logistical barriers to abortion by offering abortion pills by mail—which can take as little as 24 hours to arrive.
AOD currently operates in 23 states, with the total cost of services ranging from $239 to $289 per patient, depending on a state’s abortion law. They do not yet accept health insurance. This service includes a consultation with a physician board-certified in obstetrics-gynecology or family medicine, the medication kit (including comfort medications and the abortion pills, misoprostol and Mifeprex (the brand version of mifepristone)), pregnancy tests to ensure effectiveness, and a general follow-up via text-based surveys. AOD also has a 24/7 clinician line in the case of medical problems.
Jamie Phifer, MD, the founder and medical director of AOD, launched the startup in April 2021, shortly after President Joe Biden’s administration temporarily lifted a federal ban on telemedicine abortions on account of the COVID-19 pandemic. (The previous rule required the medicine to be provided in person.) Although the Food and Drug Administration (FDA) decided to lift the ban in December, 19 states made telemedicine abortions illegal.
The day of the Dobbs verdict, the US Department of Justice (DOJ) released a statement on behalf of US Attorney General Merrick Garland to clarify the medicine’s safety and legality: “The FDA has approved the use of the medication Mifepristone. States may not ban Mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy.” In fact, more than half of all abortions in the United States in 2020 were through medication, according to the Guttmacher Institute, an abortion rights research and advocacy organization.
Currently, AOD cannot operate in states where there is a ban on abortion pills. “We really have to go by the state rules,” says Leah Coplon, AOD’s director of clinical operations. “We require that the patient have a residential address [for the medication] and is in the state at the time of their appointment, and we use location tracking in our telehealth platform, so we can see at the time of their visit that they are actually in a state where it’s legal.” People in states where it is illegal can still procure abortion pills overseas. The nonprofit Aid Access provides online information and consultation on how best to proceed.
AOD does not require the overhead of a typical abortion clinic, such as a facility, insurance on their building, or security against protesters. The team currently has four full-time members and a handful of part-time and per diem employees, in addition to a small number of contractors to help with accounting, technology, and legal work. Because of a substantially lower overhead than brick-and-mortar abortion providers have, the business model makes AOD profitable. The organization donates 60 percent of its profits to the Abortion Care Network’s Keep Our Clinics fundraising campaign in support of on-the-ground reproductive justice efforts.
Those who facilitate abortions in states with trigger laws face an ambiguous but increasingly more likely possibility of legal jeopardy. AOD’s ability to operate in these states is severely impeded. Legal experts and reproductive rights advocates across the country have raised concerns that prosecutors in states with full bans might go as far as to use private data—such as period-tracking apps, text messages, and internet search history—to prosecute anyone involved in facilitating an abortion. International organizations with less risk, such as Aid Access, are expected to fill the gap.
The crackdown will have the greatest effect on the most vulnerable populations, according to Amy Weintraub, reproductive rights program director and deputy communications director at Progress Florida, a nonprofit organization that promotes progressive values throughout the state. “The risk is acute for populations that often are targeted by overpolicing, such as people of color and immigrants,” she says.
Telemedicine abortion is not legal in Florida, yet Weintraub emphasizes that this form of health care is revolutionary for people living in rural or poorer communities who might otherwise face lengthy travel times and costs. She also stresses the importance of abortion remaining a part of America’s health-care system, even as providers are forced to find new and innovative methods for providing it.
“Abortion is normal—one in four American women will access it during their childbearing years,” she says. “It is a part of every modern medical system, and people need access to it.”
Read more stories by Noor Noman.