Despite continuous attempts to restrict people’s abilities to have abortions, the national monthly abortion volume remains high, and telehealth plays a major role. According to the Society of Family Planning’s latest #WeCount report released in February, the fifth in a series tracking U.S. abortions post-Roe, medication abortion via telehealth now accounts for 16% of all reported abortions.

For people with disabilities who already face additional barriers to healthcare, telehealth has offered another route to receiving abortions they need or want in an environment they choose, without the added barriers some experience in arranging travel accommodations or facing medical bias in-clinic. However, telehealth is not without flaws, given the varying legal discrepancies from state to state and other things a disabled person may need to consider, such as guardianship, interpreter needs, or closed-captioning.

“Telehealth has increased to 16% of all abortion care in the United States, bolstered in part by the shield laws passed in five states providing legal protection to clinicians in states offering abortion care via telehealth,” Reproductive Health Initiative for Telehealth Equity & Solutions (RHITES) founding director Dana Northcraft said in a statement. “Despite this, far too many people are still forced to go without care. It’s time to equitably expand abortion access, including via telehealth, so that every person can get care in the way they choose, no matter who they are, where they live, or how much they make.”

One of the first barriers for disabled people is a lack of conversation around disability and sexuality, reproduction, or sexual health, says Maggie Scotece, staff attorney at Reproductive Rights Law Initiative (RRLI). Historically infantilized and desexualized, which are both forms of ableism, youth with disabilities are often excluded from these conversations or pulled out of sex education curriculum. A 2014 study published in Intellectual and Developmental Disabilities found that 84% of students with moderate to profound intellectual disabilities and 56% of students with mild intellectual disabilities received no sex education in schools.

Not having this foundational education leaves people with disabilities more likely to face sexual exploitation and disempowered in making informed sexual health choices.

“Even if there are sex ed classes in their school, a lot of times, disabled kids will not be a part of that discussion. And even if there is sex ed that they’re exposed to, it’s not tailored to disabled folks,” said Scotece. “There are a lot of assumptions about whether or not folks with mental health or developmental disabilities can consent to sexual actions, when there’s plenty of adults with disabilities who have thriving sex lives.”

This stigma increases disparities in accessing reproductive healthcare and leads to worse health outcomes, including higher risks of gynecological cancer.

“You see a lot of folks who have disabilities have higher rates of unintended pregnancy, because they’re not getting the same level of education or because they can’t afford the things they need to have safer sex practices. Or even if they can, getting access to those things is really hard,” said Scotece.

Even if a clinic meets ADA standards, OB-GYN offices and other care providers are not always physically or technologically accessible for every body.

“A lot of times they don’t have the same awareness of what it means to actually meet clients where they’re at and they don’t see disabled folks as a target population,” said Scotece.

Aspects like whether or not a ramp is installed, if exam tables are adjustable and if interpretation services are available can be the difference on whether a disabled person sees the doctor that day or not. A virtual telehealth makes these physical restrictions a non-factor.

Prior to joining RRLI, Scotece was the interim executive director of the Abortion Fund of Ohio and says that they ran into these issues a lot when connecting abortion seeks to providers.

“If we had a client who was disabled, we had to make sure that not only were our services accessible to them, but also to try and ensure that the clinic we were sending them to was also accessible,” said Scotece.

In places with abortion bans in place, where traveling out-of-state is the only option to getting an abortion, the barriers for disabled people are exponential.

“Traveling for abortion care is hard right now for a lot of folks across the country as it is, and that is 100 times more difficult for people with disabilities where travel is inaccessible to them,” said Scotece, adding that options for people who don’t drive or who are navigating public transportation can make it more difficult.

Telehealth, or telemedicine, offers a solution to at least some of these barriers by allowing patients to seek care or contact their provider without having to leave their home. It provides an alternative to visiting a doctor’s office, which can incite fear in those navigating a system in which disabled people and people of color have historically faced forced restraint, sterilization, or other treatment in which they did not consent to.

“Being able to have and access clinical care in your own home can feel a lot safer to a lot of folks,” said Scotece.

The current challenge to mifepristone poses a threat to further disrupting if and how disabled people can have an abortion. Mailed prescriptions allow people with disabilities to receive medication without having to configure how to get to a clinic. Women Enabled, Disability Rights Education and Defense Fund (DREDF), and Allen & Overy make this point in a joint amicus brief filed in the Food and Drug Administration v. Alliance for Hippocratic Medicine case, which will be heard by SCOTUS this month.

Amanda Spriggs Reid is an Equal Justice Works Fellow at Women Enabled, an organization focused on improving human rights at the intersection of gender and disability. She also feels that telehealth is beneficial to overcoming medical bias.

“[For] disabled people, who often have experiences with medical system trauma, being able to access that care within the safety of their home or having the ability to have a support person there with them for their appointments can really cut down on some of that bias,” she said, adding that people who don’t have a visible disability, or whose disability won’t be visible through screen interaction with a provider may also avoid medical bias through telehealth.

While telehealth abortion is proven to be safe and effective, it is not an option for everyone.

“There are a lot of folks who cannot use medication abortion for a variety of reasons whether or not they have an IUD in, or they have some health condition that is contraindicated for using medication abortion, or they just might have specific complications that they need clinical care,” said Scotece.

And people’s mental or physical capacity can vary from day to day, with some accommodations needed at times, but not always.

“I think what’s really important is that people have a wide variety of options to access their care. A telehealth appointment might be the most accessible thing for [someone] at that time, but maybe down the road it’s not an accessible option for them, due to a change in their circumstances or a change in their access needs,” said Reid.

Further stressing this point, she says that the same disability can manifest in individuals completely differently and it’s important to increase access to all forms of abortion care.

“Just because access to telehealth is the best option for one person, that does not negate that it’s not accessible to another person. And so both in-person clinic appointments and telehealth appointments have an important place when we’re talking about abortion access,” said Reid.