No-Test Telehealth Medication Abortion Services Provided by US-Based Clinicians in 21 States and the District of Columbia, 2020‒2022.

Abstract

<b>Objectives.</b> To evaluate the association between distance from closest abortion facility and number of fulfilled requests through no-test telehealth medication abortion (NTMA) asynchronous service. <b>Methods.</b> Using deidentified 2020-2022 electronic medical record data from Aid Access users in US states where NTMA is prescribed by US-based clinicians, we describe individual user demographics and their resident county characteristics. We conducted a county-level geospatial analysis of distance to abortion facility (Myers Abortion Facility Database) on fulfilled requests using Poisson regression. <b>Results.</b> US-based clinicians fulfilled NTMA requests to 8411 individuals in 21 states and the District of Columbia. Each 100-mile increase in distance to an abortion facility increased per-capita NTMA by 61% (95% confidence interval [CI] = 26%, 86%). Most individuals were aged 20 to 29 years (54%), had no living children (57%), were less than 6 weeks' gestation (62%), and lived in urban areas (65%). Almost half (49%) lived in higher socially vulnerable counties compared with 17% in less socially vulnerable counties. <b>Conclusions.</b> In the United States, telehealth medication abortion is a critically important service for individuals who are young, socially vulnerable, and living in counties far from abortion care facilities. <b>Public Health Implications.</b> With abortion now banned or highly restricted in 22 US states, telehealth abortion services are necessary to maintain essential reproductive health services. (<i>Am J Public Health</i>. 2025;115(2):221-231. https://doi.org/10.2105/AJPH.2024.307892).