In response to Florida's recently implemented six-week abortion ban, telehealth appointments with out-of-state physicians and mail-order abortion pills are expected to play a crucial role in aiding women within the state to safely terminate their pregnancies. Advocates on both sides of the abortion debate anticipate legal challenges, as red states assert their right to restrict abortion and blue states strive to protect abortion providers.

While Florida law prohibits telehealth appointments for abortion at any stage of pregnancy, women can still seek virtual visits with physicians in other states where the procedure remains legal for medication abortions, according to Rachel Rebouché, dean of the Temple University Beasley School of Law in Philadelphia. To protect physicians who provide reproductive health care, even if the patient is located in a different state, seven states—California, Colorado, Maine, Massachusetts, New York, Vermont, and Washington—have enacted shield laws. Some providers in these states offer services to patients across the country, including those residing in states with abortion restrictions or bans.

Aid Access, an organization already utilizing out-of-state physicians for telehealth abortion services, currently provides abortion pills to an estimated 9,500 women in the United States each month, including up to 800 per month in Florida, according to founder and executive director Dr. Rebecca Gomperts. The Guttmacher Institute reports that medication abortion, which involves a combination of the pills mifepristone and misoprostol, accounted for 63% of all pregnancy terminations in the United States in 2023.

Despite the Food and Drug Administration's decision to allow abortion pills to be prescribed through telehealth as of 2020, the Society of Family Planning highlights that 16% of all medication abortions now involve virtual visits or online appointments, based on data submitted by abortion providers. The convenience and accessibility of telehealth have contributed to a recent rise in abortions, even amidst restrictions in 14 states and tight regulations in five others, notes Rebouché. In 2023, there were over 1 million abortions in the United States, a 10% increase since 2020 and a 12% increase since 2019, following the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization that overturned the constitutional right to abortion.

Opponents of abortion argue that out-of-state doctors have no right to undermine a state's laws, emphasizing the duty of states to protect vulnerable citizens and families. Erin Hawley, vice president of the Center for Life and Regulatory Practice with the Alliance Defending Freedom, asserts that one state should not interfere with another's efforts to safeguard lives and health, including the lives of unborn children. Meanwhile, those in favor of abortion rights continue to work towards expanding access to abortion pills, pushing against restrictions on their mail distribution. In 2022, anti-abortion rights doctors and groups sued the FDA in an attempt to limit access to mifepristone, with the Supreme Court expected to issue a decision on the case later this summer.

As more states enact abortion restrictions, telehealth appointments with out-of-state doctors are predicted to grow more popular, according to Dr. Abigail Aiken, associate professor at the LBJ School of Public Affairs at the University of Texas at Austin. Following Texas' six-week abortion ban in 2021, the average number of requests for medication abortion via Aid Access surged from 11 per day to 138 per day within the first week. With limited options for abortion across the South, many women find telehealth appointments more convenient and cost-effective than traveling to another state. Before the ban, women from across the Southeast traveled to Florida for abortion care, accounting for 13% of people undergoing abortions in the state in the first half of 2022.

However, accessing abortions out of state can be financially burdensome for Florida women, with medical costs, travel expenses, and child care adding up to over $2,000, warns Dr. Jennifer Lincoln, an OB-GYN and founder of Three for Freedom. Serving the substantial demand of approximately 84,000 abortions performed in Florida last year will be challenging, even with telehealth and out-of-state providers. This raises concerns that those unable to travel or access abortion pills may resort to unsafe methods of termination or be forced to carry their pregnancies to term.

Florida physicians who violate the state's abortion law may face up to five years of imprisonment. If an out-of-state doctor prescribes abortion pills for a Florida patient, there is the possibility that Florida's attorney general could seek prosecution through collaboration with the state where the doctor practices, or initiate civil or criminal investigations. However, prosecuting doctors in states with shield laws may prove more difficult, as extradition may not be granted if the doctor is not considered a fugitive and is residing in a state with protective legislation.

The clash between states regarding abortion regulations could potentially result in a legal battle, ultimately reaching the Supreme Court. The issue around respecting neighboring state laws has raised concerns among experts and advocates, with Kristi Hamrick, vice president of Students for Life Action, stating that selective adherence to laws by states will likely lead to a court intervention. Florida voters will have the opportunity to voice their opinions on abortion access this November, when a constitutional amendment on the matter will be on the ballot.

In a time of evolving abortion legislation, the future of telehealth abortion and the rights of women across the United States continue to be hotly debated, leaving many uncertain about the accessibility and safety of reproductive healthcare.