Some say telemedicine access to abortion pills is life-saving for survivors of domestic violence

Carrie Frail was in the process of leaving an abusive relationship when she discovered she was pregnant. Her partner told her he could punch her in the stomach until she miscarried and that would save some money.

“I firmly believe he would have killed me at some point, whether accidentally or intentionally,” Frail said.

In 2008, while serving in the U.S. Air Force, she had a medication abortion at a Planned Parenthood clinic in St. Louis, Missouri. She was relieved to have the option of using medication instead of surgery and was therefore less likely to be incapacitated. It wasn’t an straightforward decision, she said, but she knew if she hadn’t done it, she would never have been able to get away from this partner.

“I was too wrapped up in him mentally and emotionally to leave without giving him a phone number or letting him know where I was,” Frail said. “I still believe that an abortion saved my life.”

Access to telemedicine prescriptions for mifepristone, one of two drugs used to terminate pregnancies in the first trimester or treat miscarriages, is at risk due to an ongoing lawsuit in Louisiana. That state government has sued the U.S. Food and Drug Administration, seeking to overturn the agency’s 2023 rule that allows for the dispensing of medications without an in-person visit.

Researchers, advocates and survivors of domestic violence say it is critical to keep access to telemedicine available for people in abusive relationships who need cautious abortion options. However, the Louisiana lawsuit argues in part that mifepristone has been used as a weapon against pregnant women in abusive relationships and should not be available via telemedicine.

The 5th U.S. Circuit Court of Appeals temporarily blocked the FDA’s 2023 rule in early May, requiring in-person visits for mifepristone prescriptions for two days, before the U.S. Supreme Court put that decision on hold in an emergency appeal. The Court, with the exception of Justices Samuel Alito and Clarence Thomas, decided to keep the rule while the appeal process is still ongoing. But the rule could be overturned again later and the entire case could end up in the Supreme Court.

Data from the federal Centers for Disease Control and Prevention’s National Intimate Partner and Sexual Violence Survey from 2023-24 showed that approximately 34% of women and 17% of men experienced physical or sexual violence or stalking by an intimate partner. These numbers could be higher because of the sluggish reporting of incidents of abuse. States with high rates of violence include many with near-total abortion bans, including Arkansas, Indiana, Oklahoma, Tennessee and West Virginia — meaning residents who are victims of reproductive coercion have less access to abortion drugs.

Research shows pregnancy is a time of increased risk in a domestic violence relationship, and intimate partner violence is one of the most common non-obstetric causes Caused Cause of death in pregnant and postpartum women. These risks are highest among Black and Indigenous people in the United States.

Reproductive compulsion

Louisiana resident Rosalie Markezich is a plaintiff in the lawsuit over access to mifepristone. She says the availability of the drug without a clinic visit allowed her boyfriend to order the pills in 2023 and pressure her to take them. In her written statement in the case, Markezich said the pressure caused ongoing trauma and that if she had needed to see a doctor beforehand, she could have told the provider that she did not want an abortion and the pills would never have been prescribed to her.

Anti-abortion groups, including Susan B. Anthony Pro-Life America and Family Research Council, filed amicus briefs with the U.S. Supreme Court about the kind of coercion Markezich said he experienced. The telemedicine option prevents in-person coercion exams, Susan B. Anthony told Pro-Life America, and the in-person requirement provides “a line of defense” against reproductive coercion. The Family Research Council also argued that the FDA’s initial approval of the telemedicine provision did not include a thorough study of how it could be used to coerce and that it should be repealed.

Liz Tobin-Tyler, a professor of health services, policy and practice at the Brown University School of Public Health, said it is very common for people in abusive relationships to experience what researchers call reproductive coercion. According to the American College of Obstetricians and GynecologistsThese include situations in which a partner attempts to control when and how a pregnancy occurs, either by intentionally causing a pregnancy or by forcing someone to terminate it, as in the Markezich case.

Coercion can also occur when a partner interferes with contraceptive methods, for example by attempting to force the apply of a particular method or intentionally refraining from using contraceptives. Tobin-Tyler said sometimes the abusive partner attends doctor’s appointments to try to influence decisions related to birth control and other discussions about medical care.

“It all comes down to that aspect of control,” she said.

Robin Turner, Montana director at the equality organization Legal Voice, said what happened to Markezich was terrible, but Louisiana could prosecute Markezich’s partner under current laws, including drug-related harm. She said reintroducing the requirement to take mifepristone locally would harm many other people as it would apply nationwide.

“It is not a reasonable or proportionate way to deal with what happened to the client,” Turner said. “We must take what happened to the plaintiff seriously – and understand that it is not effective to take away (access) from him.”

Turner co-authored a meager for Legal Voice was submitted to the U.S. Supreme Court as part of an emergency appeal hearing about the importance of access to mifepristone for people in relationships characterized by domestic violence.

“These relationships are all about the world becoming smaller, and we don’t want our systems to replicate the dynamics of abuse. But that’s exactly what happens when the government denies them access to the health care they need,” Turner told Stateline.

Safety planning for hotline callers

Kaelah Oberdorf, 24, said she was taking contraceptives when she discovered she was pregnant in New York state in 2023.

She was in an emotionally abusive relationship, struggling financially, and still recovering from the postpartum depression she suffered after giving birth to her first child at age 20, even though she thought she couldn’t get pregnant due to an illness. The depression was so severe that she had to be hospitalized. She decided that terminating the pregnancy was the right thing to do for her mental health and for the daughter she already had.

“I didn’t want to be tied to him for life, I didn’t want my daughter or any of my children to be tied to him for life,” said Oberdorf, who now lives in Georgia. “I already had a living child who didn’t need to be kept in that situation, and if I had had another child, I wouldn’t have been mentally able to cope even if I had left them.”

Research also shows that pregnant and postpartum women in rural areas are more likely to experience violence in their relationshipspossibly because they are further away from face-to-face medical care, which could lead to fewer abuse screenings.

Elizabeth Ling, associate director of legal services at the nonprofit Hotline If/When/How, which provides reproductive legal assist, estimates that the hotline receives between five and 10 calls a week from people discussing experiences of intimate partner violence, whether physical, emotional or some form of coercion. She said callers in rural communities are among those who need access to medication abortion via telemedicine and by mail because they are often the furthest from a clinic and cannot travel because a partner is actively monitoring their movements.

“If/When/How” discusses callers’ legal options and advises them on legal risks, which Ling says is a major concern for people in abusive relationships. They often fear that their partner will report them for having an abortion, which can lead to unwanted attention from police and investigations, even if it does not result in charges.

The hotline also helps people create a safety plan for receiving abortion medications by discussing steps such as: B. where medications are sent, who has access to that mailbox, and how they will cope in a situation where a partner is tracking their movements.

“Abortion pills are truly a lifeline for those who call us and share their experiences with us,” Ling said.

Frail, who still lives in Missouri, now has a daughter and son who are in their 20s. She has recently left many voicemail messages for Republican U.S. Senators Josh Hawley and Eric Schmitt, who have advocated for withdrawing FDA approval of mifepristone and called for federal investigations into drugmakers. In her messages she says that she has become a better mother because she can decide for herself when she has her children.

“I know if I hadn’t had an abortion, I would never have been able to move on from that abusive partner,” Frail said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.