Olivia Engle
Telemedicine abortion is not equally accessible in the United States. Prior to Dobbs v. Jackson Women's Health Organization (2022), state-level restrictions on telemedicine abortion meant that abortion seekers in 18 states could not access telemedicine abortion services within their state - reinforcing extant geographical inequity in abortion access. However, understanding the benefits of telemedicine abortion to increase the availability of abortion, abortion providers and seekers co-developed a strategy for access, which this paper calls cross-border telemedicine abortion (CBTA). Rather than access care remotely, as is typical of telehealth, patients physically travel across state borders to have a phone consultation and pick up their pills from the post office. This paper describes this phenomenon and nuances discussion of the potential of telemedicine and digital health to transcend distance and resolve rural health inequalities. This paper draws on a case study of telemedicine abortion provider Just The Pill and semi-structured interviews with staff and rural patients who accessed this abortion care pathway prior to Dobbs. It suggests that distance may not be the paramount barrier to care for rural women because they are still travelling long distances. Rather, the phenomenon of CBTA suggests that a combination of barriers influences abortion decision-making for rural women and that CBTA may present a viable spatial solution to these barriers.