Background

The U.S. Food and Drug Administration (FDA) approved the use of mifepristone for early nonsurgical abortion in 2000. Since then, states have enacted several types of restrictions targeting medication abortion. Many states limit provision of medication abortion to physicians, despite recommendations from the World Health Organization and the National Abortion Federation that midlevel providers, such as physician assistants and advanced practice nurses, can safely provide medication abortion. Other states have adopted laws that require mifepristone to be provided in accordance with the FDA-approved label for mifepristone. In 2016, the FDA updated the label protocol to follow a newer regimen that offers numerous advantages to women, including making medication abortion available for an additional three weeks of gestational age. Moreover, in an effort to reach rural women, some providers began offering medication abortion services via telemedicine. However, some states require clinicians to be in the physical presence of the patient when prescribing abortion-inducing drugs. These laws therefore restrict the use of telemedicine in the case of abortion and reduce access to abortion services in rural areas.