Some argue that telehealth and access to abortion pills save the lives of victims 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, which would save her some money.

“I firmly believe he would have killed me at some point, either accidentally or on purpose,” Frail said.

In 2008, while serving in the United States Air Force, she performed a medical abortion at the Planned Parenthood clinic in St. Louis, Missouri. She was relieved that she could operate medication instead of surgery, which meant she could take less time off work. She said it wasn’t an simple decision, but she knew that if she didn’t make it, she would never be able to break free from this partner.

“I was too wrapped up in his life mentally and emotionally that… I had to be able to leave without giving him my phone number and telling him where I was,” Frail said. “I still believe that abortion saved my life.”

Access to telehealth prescriptions for mifepristone, one of two drugs used to terminate pregnancies in the first trimester or treat miscarriages, is at risk following an ongoing lawsuit in Louisiana. The state’s government has sued the U.S. Food and Drug Administration in an attempt to invalidate the agency’s 2023 rule allowing drugs to be dispensed without an in-person visit.

Researchers, advocates and survivors of domestic violence say it is critical to provide access to telehealth for people in abusive relationships who need considerate abortions. 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 through telehealth.

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 stayed that decision on an emergency appeal. The Court, with the exception of Justices Samuel Alito and Clarence Thomas, decided to maintain this principle while the appeal case is pending. However, this rule may later be overturned again and the entire case may end up before 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 had experienced physical or sexual violence or stalking by an intimate partner. These numbers may be higher due to a reluctance to report incidents of violence. Among the states with high rates of violence are many states with near-total abortion bans, including Arkansas, Indiana, Oklahoma, Tennessee and West Virginia, which means residents who are victims of reproductive coercion have less access to abortion drugs.

Research shows that pregnancy is a time of increased risk in a relationship where domestic violence has occurred, and intimate partner violence is the leading non-obstetric cause. cause deaths among pregnant and postpartum women. This risk is highest among Black and Indigenous people in the United States.

Reproductive coercion

The plaintiff in the mifepristone access lawsuit is Louisiana resident Rosalie Markezich, who claims that the drug’s availability without a clinic visit allowed her boyfriend to order the pills in 2023 and pressure her to take them. In her written statement on the matter, Markezich stated that the oppression caused ongoing trauma and that if she had had to see a doctor sooner, she could have told the doctor that she did not want an abortion and the pills would never have been prescribed.

Anti-abortion groups, including Susan B. Anthony Pro-Life America and the Family Research Council, submitted amicus briefs to the U.S. Supreme Court about the type of coercion Markezich said she experienced. The telehealth option prevents in-person screening for coercion, Pro-Life America’s Susan B. Anthony said, and the in-person attendance requirement provides a “line of defense” against reproductive coercion. The Family Research Council also argued that because the FDA’s initial approval of the telehealth service did not include a thorough examination of how it could be used for coercion, it should be rejected.

Liz Tobin-Tyler, a professor of health services, policy and practice at the Brown University School of Public Health, says people in abusive relationships often experience what researchers call reproductive coercion. According to American College of Obstetricians and Gynecologistswhich includes situations in which the partner tries to control when and how the pregnancy occurs, either intentionally causing the pregnancy or forcing someone to terminate it, as in the case of the Markezis.

Coercion may also occur when a partner interferes with contraceptive methods, for example by trying to force a particular method or by deliberately not using contraception. Tobin-Tyler said sometimes an abusive partner attends doctor visits to try to influence decisions about birth control and other discussions about medical care.

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

Robin Turner, Montana director of the gender equality group Legal Voice, said what happened to Markezich was terrible, but Louisiana could prosecute Markezich’s partner under existing laws, including for drug harm. She said restoring the requirement to administer mifepristone in person would harm many more people because it would apply nationwide.

“This is not a reasonable or proportionate way to deal with what happened to the client,” Turner said. “We need to take seriously what happened to the plaintiff and understand that depriving him (of access) is not effective.”

Turner is co-author of A miniature in the Legal Voice case filed with the U.S. Supreme Court during extraordinary appellate proceedings that focused on the importance of access to mifepristone for people in domestic violence relationships.

“A lot of being in relationships like this is that the world is getting smaller and we don’t want our systems to mimic the dynamics of harassment. But that’s what happens when the government takes away their access to the health care they need,” Turner told Stateline.

Safety planning for people calling the hotline

Kaelah Oberdorf, 24, said she was using birth control when she discovered she was pregnant in 2023 in upstate New York.

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

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

Studies also show that pregnant and postpartum women in rural areas they are more likely to experience violence from their partnerperhaps because they are located further from in-person medical care, which may contribute to lower rates of sexual harassment screening.

Elizabeth Ling, deputy director of legal services at the nonprofit If/When/How hotline, which offers reproductive legal assistance, estimated that the hotline receives five to 10 calls a week from people who say they have experienced intimate partner violence, whether it is physical, emotional or other forms of coercion. She said callers from rural communities are some of the people who need access to medication abortion via telehealth and mail because they are often closest to the clinic and unable to travel because their partner is actively monitoring their movements.

If/When/How talks to callers about their legal options and advises them on legal risks, which Ling says is a major concern for people in abusive relationships. They are often afraid that their partner will report the abortion to them, which may attract police attention and investigations, even if it does not result in charges.

The hotline also helps patients prepare a safety plan for taking abortion medications, going through steps such as where to ship the medications, who has access to that mailbox and how to deal with a partner spying on their movements.

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

Frail, who still lives in Missouri, now has a daughter and a son who are both 20 years aged. Most recently, she left multiple voicemails for Republican senators Josh Hawley and Eric Schmitt, who advocated withdrawing FDA approval for mifepristone and called for federal investigations of drugmakers. In her messages, she claims that being able to choose when she gives birth to her children has made her a better parent.

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

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