Since the Supreme Court ruling in June stripping the constitutional right to an abortion, providers and officials in Maryland have been looking for ways to expand access to people within and outside the state — and the efforts in Maryland are getting a boost from a new provider and new federal and local funding.
On Tuesday, the U.S. Department of Health and Human Services announced reproductive health research grants worth more than $6 million across the country, with more than half going to Maryland organizations and a university. A $750,000 Title X Family Planning Program grant also went to the Baltimore City Health Department.
Baltimore officials also recently announced the first $167,900 in grants from its new Abortion Protection Fund to strengthen reproductive health services for residents and travelers.
And the telehealth company Wisp launched services in Maryland in mid-September, joining at least a half dozen other groups in the state offering virtual appointments for medication abortions, with pills mailed or picked up at a local pharmacy.
The federally funded research “will enhance the work of our grantees working to provide critical reproductive health services across the U.S.,” said Jessica Swafford Marcella, deputy assistant secretary for population affairs and director of the U.S. Office of Adolescent Health, in a statement announcing the funds.
The federal funds will pay for research and analysis aimed at improving family planning, decreasing teenage pregnancy and expanding adolescent sexual and reproductive health programming. The recipients of federal funding include the University of Maryland, Baltimore, and two Washington-area research and advocacy groups, Child Trends and Healthy Teen Network.
The money from the local Abortion Protection Fund, backed by the Baltimore Civic Fund, will go toward more front line services, funding for those who can’t afford it, contraception and staffing in provider offices.
Meanwhile, Wisp officials said it’s aiming to address immediate needs for people who can’t or don’t want to visit an office for sexual or reproductive health services. Twenty-two states allow medication abortions via telehealth, and the company expanded last month to Maryland and five others.
Telehealth visits for all kinds of medical needs grew in use during the coronavirus pandemic, and became viable for medication abortions when the Biden administration changed rules in 2021 allowing the abortion drugs to be dispensed outside of medical facilities. Such appointments are expected to increase the number of medication abortions, federally approved since 2000 and already accounting for more than half all abortions, according to the Guttmacher Institute, a New York-based research and reproductive rights organization.
“We saw a need,” said Ahmad Bani, CEO of Wisp, which is majority owned by the Canadian digital health technology firm WELL Health Technologies Corp.
“The conditions we treat, sexual and now reproductive health, tend to have a lot of urgency,” he said. “You get in touch and can see a doctor in two to three hours and get medications the same day by picking them up at a pharmacy or having them delivered in a couple of days.”
Wisp plans to offer 24-hour-a-day services with appointments made within a couple hours of contact. A hotline will be available for follow-up and complications, which have shown to be rare. Bani said there also are special protocols to protect privacy, from limited data collection on patients and storage safeguards. Wisp also has turned off tracking to the site.
Bani and others noted there will be limits to medication abortions via telehealth. The drugs mifepristone and misoprostol are approved for only the first 10 weeks of pregnancy, a potentially narrow window since some people don’t know they are pregnant for 6 or 8 weeks.
Doctors have to be licensed where the services are provided and patients have to be physically in states where abortions are legal. Some of Wisp’s doctors have licenses in more than one state to assist in scheduling, but other providers leery of legal ramifications are only offering services to residents of their states.
Many states require a doctor to prescribe drugs for medication abortions or an in-person ultrasound, and 19 specifically ban medication abortions via telehealth, according to the Kaiser Family Foundation, adding the tallies are in flux as state legislatures act and courts rule.
Fourteen states now ban abortions and most have some restrictions, with more expected. Maryland permits abortions until the fetus is viable outside the womb, at about 24 weeks, and later to protect the health or life of the pregnant person or for a fetal anomaly. Maryland also now requires public and private insurers to cover abortions, though not related costs. Insurance elsewhere is inconsistent and the median cost for an abortion exceeds $500.
Lauri Sobel, associate director of women’s health policy at Kaiser, said access to abortion always has been uneven, even in states where it’s legal, because of geography and income. Some people won’t have time off, child care or money for travel within a state. They are increasingly relying on abortion funds across the country, including one in Baltimore, to help pay for direct and indirect abortion services.
The Baltimore Abortion Fund spent $250,000 in 2021 on abortion and related services, but officials expected costs in the initial six months after the court ruling to reach $6 to $8 million. The group was among those receiving a Baltimore Abortion Protection Fund grant, which ranged from $50,000 to $80,000.
Sobel said expansions of abortion services, including through telehealth, will help close gaps in services around states such as Maryland.
“For some people it’s not expanding access but making access better because they prefer to be at home and get pills in the mail,” she said.
Maryland providers still are ramping up staffing, including with nurses and physician assistants after the state joined 18 others in allowing them to provide abortion services after training.
That effort is going slowly as $3.5 million allocated for that training is not being released early by Gov. Larry Hogan, who does not support non-physicians performing abortions, said Karen Nelson, president and CEO of Planned Parenthood of Maryland. The group is training its own providers and also was a recipient of one of the Baltimore grants for staff.
Nelson said funding will be crucial as more residents and visitors tap services in Maryland, and more philanthropic and individual donors have been contributing: Funds raised to help people who could not afford care grew to $266,000 in 2022 from about $100,000 the year before.
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Nelson agreed access continues to be inconsistent, even in Maryland. Two-thirds of counties have no abortion provider, she said, prompting the group to add telehealth services last summer. She said virtual appointments for local patients enable more in-person appointments for out-of-state visitors while eliminating hardships in the state. The first patient was from the Eastern Shore and didn’t have to drive across the Chesapeake Bay Bridge, she said.
Nelson said there has been an uptick in patients visiting from other states, and the group is preparing for more as bans and restrictions are added elsewhere and legal challenges resolve.
“Your ZIP code shouldn’t determine the kind of health care you receive,” she said.
Melissa Grant, chief operating officer for carafem, which provides services in Maryland and 17 other states, said there is fear and confusion since the Supreme Court ruling in states where services are suddenly restricted, such as neighboring West Virginia. People don’t know how or where to get an abortion, which primarily are offered in independent clinics such as carafem’s.
They are finding their way to carafem, however. Those traveling more than 100 miles to the organization’s health center in Chevy Chase in the Washington suburbs doubled in August, she said. In-state, demand for “discreet” telehealth services jumped 20% since the June ruling. And though the group accepts Medicaid, carafem also works with local and national funds, including the National Abortion Federation, to help defray all kinds of costs.
“Anyone who can get pregnant may need to access abortion care. The people carafem serves represent a broad variety of demographics, including a range of sexual identities, gender identities, ages, incomes, disabilities, geographies and more,” said Grant, adding that one in four people who can become pregnant will access abortion care in their lifetimes, and most seeking abortions are aged 18-30, likely to be unmarried and already a parent.
“There are also complex issues for people who are less economically stable, live in rural communities, or for people who have black or brown skin,” she said. “Lack of access to abortion care and trouble obtaining all medical services within their communities disproportionately harms them even more.”