Knowledge of Remote Medication Abortion Among Patients Traveling From States That Restrict Abortion.

Abstract

IMPORTANCE: Following widespread state-level restrictions, millions seeking abortion in the US cannot access local clinic-based care and must travel long distances or utilize remote medication abortion. Understanding factors shaping care decisions can improve access in restrictive legal environments. OBJECTIVE: To explore how individuals traveling from states with restrictions on abortion provision perceive remote medication abortion and to identify factors affecting their care decisions. DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, one-on-one, virtual, in-depth interviews were conducted at an abortion clinic in Kansas. Participants included English-speaking and Spanish-speaking patients who traveled from states that restrict abortion provision to Kansas for medication abortion care from March to September 2025. Audio was transcribed, analyzed in Dedoose, and summarized using an inductive-deductive thematic approach. EXPOSURES: Out-of-state travel for abortion care. MAIN OUTCOMES AND MEASURES: The primary outcomes were awareness, knowledge, and perceptions of remote medication abortion and factors shaping care decisions. RESULTS: Among 37 patients (median [IQR] age, 27 [24-30] years; 24 Texas residents [65%]), 26 (70%) were aware of remote medication abortion before traveling, and 7 (19%) considered it. Barriers included privacy and legal concerns, discouragement from health care resources, and lack of response from online intake. Eleven patients (30%) learned about remote medication abortion after traveling; 6 patients (16%) expressed retrospective interest. Awareness was more common among those with more education and Texas residency. Participants were uncertain about the legality of remote care and legitimacy of sources; they questioned the discretion and timeliness of mail delivery and the security of sharing personal information online. Participants desired clinical reassurance, minimal legal risk, and in-person guidance. After traveling, most retained a preference for in-person care, but some were open to remote options. CONCLUSIONS AND RELEVANCE: In this study of patients who traveled to Kansas for medication abortion, awareness of remote care was high, yet participants prioritized the professional oversight and legal security of in-clinic care. These findings suggest that for travelers, human connection and clinic credibility outweighed the convenience of remote options. Enhancing the legitimacy of online sources and clear legal guidance are essential for optimizing remote care as a viable alternative to out-of-state travel.