Telehealth and in-clinic abortion services reach different patients

Clinical takeaway: For patients seeking medication abortion, telehealth appears to improve access for those facing the greatest geographic and structural barriers, particularly in states with highly restrictive abortion policies.

Since the 2022 Dobbs decision, many patients in abortion-restrictive states must either travel long distances for in-person care or use telehealth-based medication abortion services. Understanding who uses each pathway can help clinicians, health systems, and policymakers identify gaps in access and tailor services accordingly.

In a cross-sectional analysis of 13,548 adults receiving medication abortion between February and June 2024, researchers compared 12,823 telehealth patients with 725 patients who traveled to a Kansas clinic for in-person care. The study included residents of Texas, where abortion services are largely banned, and Kansas, where clinic-based abortion remains available.

Telehealth users were consistently more likely to obtain care earlier in pregnancy. Among Texas residents, 61% of telehealth patients were less than 6 weeks pregnant, compared with 27% of in-clinic patients. Similar findings were seen in Kansas (59% vs 33%).

Patients receiving telehealth care were also more likely to have no children. In Texas, 44% of telehealth users had no children compared with 7% of clinic patients; in Kansas, the figures were 51% and 4%, respectively.

Distance from care appeared to be a major driver. Nearly all Texas patients lived more than 200 miles from an abortion facility, and telehealth served a greater share of those living more than 400 miles away. Patients from rural and smaller metropolitan Texas counties were also more likely to use telehealth than those from large metropolitan areas.

The authors concluded that telehealth and in-clinic medication abortion are serving “distinct patient populations rather than interchangeable groups of abortion seekers,” with telehealth helping reach populations that have historically faced greater barriers to reproductive health care.

Source: Fiastro AE, et al. (2026 Oct 22) JAMA Netw Open. Telehealth vs In-Clinic Medication Abortion Provision