Engle, Olivia Paige (2024) Abortion delivered? : the impact of telemedicine abortion services on abortion access and care in the rural United States. PhD thesis, Birkbeck, University of London.
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Abstract
Telemedicine abortion has been lauded as a ‘game changer’ for women and pregnant people who live far away from an abortion clinic. By remotely prescribing and dispensing the ‘abortion pills’ (mifepristone and misoprostol), telemedicine abortion promises to eliminate travel distance as a barrier to abortion care by making the pills travel to the patient. However, this idea has not been sufficiently interrogated in the context of the United States where ‘direct-to-patient’ telemedicine abortion services were not available until 2020 in response to the COVID-19 pandemic. This research therefore asks, to what extent does telemedicine abortion reduce, eliminate, or help to reimagine geographic barriers to abortion care in the US? I focus on a case study of one of the first fully telemedicine abortion providers in the US: Just The Pill (JTP). Drawing on spatial analysis using GIS and semi-structured interviews with patients, staff, and partners of JTP, I explore geographic barriers to abortion care for rural women and consider how telemedicine abortion addresses them, in terms of abortion access and experience. I find that distance was not the primary barrier to abortion care nor the only barrier that was considered geographical. Rather, rural women imagined and encountered multiple practical, socio-cultural, and economic barriers which led them to choose telemedicine abortion. In practice, telemedicine abortion did not preclude travel; depending on state of residence and restrictions on telemedicine abortion, patients travelled by car and plane to other states to have their remote consultation and pick up the pills. Nevertheless, rural women considered it more convenient than going to an abortion clinic. Moreover, telemedicine abortion facilitated participants’ control over the timing of the abortion, the space in which it took place, and the people who accompanied them during the process, which enabled more privacy, comfort, and ease. I ultimately conclude that telemedicine abortion is not a panacea for abortion access for rural women and pregnant people, because patients are still travelling across state lines— what I call ‘cross-border telemedicine’. Nevertheless, telemedicine abortion advances access to and shapes new experiences of abortion care because it displaces care away from clinical spaces which participants saw as expensive, inconvenient, and potentially stigmatising.
Metadata
| Item Type: | Thesis |
|---|---|
| Copyright Holders: | The copyright of this thesis rests with the author, who asserts his/her right to be known as such according to the Copyright Designs and Patents Act 1988. No dealing with the thesis contrary to the copyright or moral rights of the author is permitted. |
| Depositing User: | Acquisitions And Metadata |
| Date Deposited: | 09 Feb 2024 16:00 |
| Last Modified: | 09 Feb 2024 17:15 |
| URI: | https://eprints.bbk.ac.uk/id/eprint/52983 |
| DOI: | https://doi.org/10.18743/PUB.00052983 |
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