For her first abortion, Salina drove with a friend two hours to a family clinic in Eugene.
The 20-year-old walked past children playing in the waiting room, feeling the irony of what she was there to do. She was wide awake for the procedure. She fixated on the loud whirring of the vacuum-like machine in front of her. On the way home, she threw up on the side of the road.
Her second abortion came at the age of 38 in a non-descript FedEx box, with pills neatly packaged in separate manila envelopes. One pill, mifepristone, blocks a critical pregnancy hormone. Another, misoprostol, taken 24 to 48 hours later, triggers contractions that would rid the uterus of the embryo and any tissue. A third medication is to ease the nausea.
Since 2016, Oregon women have had the option to end their early pregnancies at home with an abortion through TelAbortion, a telemedicine program that allows women to bypass many of the traditional in-person clinical visits and consultations needed to get an abortion. Now, as the coronavirus pandemic has forced a meteoric rise in demand for remote care, abortion by telemedicine has become an even more crucial resource for women with limited options.
Salina, who is going by her first name for privacy reasons, got an abortion through TelAbortion in November.
“I can’t have another mouth to feed when I can hardly provide for the two that I have,” she said. She raises two girls by herself.
TelAbortion is a research study sponsored by Gynuity Health Projects, a nonprofit reproductive health organization based in New York. It began operating in Oregon, Washington, New York, and Hawaii in 2016 and has expanded to 16 states, adding five as the pandemic exploded. At the start of February, the program has conducted 3,327 screenings and mailed 1,654 packages nationwide.
Oregon and Washington women can access the option through Planned Parenthood Columbia Willamette. Another study site, the Oregon Health & Science University, is currently on pause to re-evaluate how the program is conducted and look for ways to improve access, said lead researcher Dr. Maureen Baldwin.
The Planned Parenthood site has mailed 128 packages since the start of the research program, and the OHSU site has sent 158.
Oregon is the only state with no laws restricting abortion. Legislation passed in 2017 requires insurers to cover abortion services with no out-of-pocket cost, and those on the Oregon Health Plan wishing to get an abortion are covered as well.
The state was chosen for TelAbortion because of this unrestrictive legal environment and for having a large rural area that could benefit from telemedicine services, said Dr. Paula Bednarek, the Planned Parenthood Columbia Willamette medical director.
More than 20% of Oregon reproductive-age women live in a county that does not have an abortion provider, according to a report by the Guttmacher Institute, a reproductive rights nonprofit.
When Salina called the Eugene Planned Parenthood to ask about abortion options, they did not have available appointments for weeks. For an in-person abortion, she would’ve had to travel the two hours to Portland.
Instead, she had her telemedicine appointments and calls while sitting in her garage in the early mornings, while her kids were still asleep.
“[TelAbortion] was probably the only way I would have been able to do this,” Salina said, “because just the gas and stuff alone to get over, and having somebody that has to pick you up because you can’t drive home on your own, and then having to find somewhere for my kids to be while I went and did that. It was just a lot of things that would have had to go into going to a facility.”
Dr. Paula Bednarek holds up the packages containing a two-step abortion medication at Planned Parenthood Northeast Portland Health Center, on February 9, 2021.Brooke Herbert/The Oregonian
The drugs used in a medication abortion also face restrictions that limit women’s access to…