The large majority of abortions in Vermont in 2020 were performed using medication rather than surgery, according to new data from the Department of Health.
Medication abortion is typically performed at home using a combination of two drugs: mifepristone and misoprostol. The method has risen in Vermont over the past 14 years, according to the data. But experts say that the pandemic created higher-than-ever demand for the pills, while loosened federal regulations have made the drugs more accessible.
The Vermont Department of Health reported there were 1,227 abortions in the state in 2020. That’s about 200 abortions per 1,000 live births, compared to 170 per 1,000 in 2019 — a slight uptick after years of decline.
Medication abortions accounted for 75% of those procedures, according to the department. That’s higher than the national average of 54% in 2020, according to the Guttmacher Institute, an abortion rights advocacy group.
“2020 marked a change in clinical practice because of the pandemic,” Alison Bates, director of medication abortion, sedation and ultrasound at Planned Parenthood of Northern New England, said in a statement.
In the earliest stages of the pandemic, Planned Parenthood moved from allowing patients to choose their abortion method to selecting medication abortion by default for patients who were 11 weeks or less into their term.
As to why 2020 saw an uptick in the total number of abortions, Bates said that she believed it was a response to the “uncertainty” of the early days of the pandemic.
The majority of people seeking abortions in Vermont that year were in their 20s or early 30s, according to the health department. About half had at least one living child, and about two-thirds were single at the time of their abortion.
In late 2020, Planned Parenthood allowed patients to begin scheduling in-clinic abortions again. But some of the changes made to medication abortion access have continued past the early days of the pandemic.
A federal court ruling in July 2020 allowed providers to mail their patients abortion pills. In December 2021, the U.S. Food and Drug Administration permanently removed all in-person requirements and made it easier for pharmacies to stock the drugs.
Carrie Baker, a professor of women and gender studies at Smith College, said new telemedicine providers have cropped up to offer abortion services, particularly so people in rural areas “don't have to travel long distances to get to clinics for in-person care.”
There’s no single directory of all abortion providers in Vermont, because certain qualified physicians can choose to provide abortions in addition to their regular practice. But the National Abortion Federation lists six in-person clinics, all located in areas of higher population density.
Some Vermont residents would have to travel 30 miles or more to get to a clinic — from the Northeast Kingdom, for example, the closest clinic is in Barre. The University of Vermont Medical Center in Burlington is the only provider in Vermont for abortions past 22 weeks gestation, when medication is not an option.
That means that Vermonters not only have to pay for the abortion, but often child care costs and increased travel costs, said Catherine Coteus, a board member for Vermont Access to Reproductive Freedom, which provides funding for Vermonters to get abortions.
Three telemedicine providers — Abortion on Demand, Abortion at Home by carafem, and Aid Access — will ship to any Vermont address after a telehealth visit.
For some patients across the country, medication also comes with the benefits of privacy and comfort, Baker said. “People won't have to cross protest lines. They don't even have to have ultrasounds or other pelvic exams. They can just have the pills mailed directly to their house.”
Medication is also less expensive. Abortion pills by telemedicine cost about $150, compared to $500 to $700 on average for an in-clinic abortion, Baker said. They’re considered “very safe,” she said, although they do come with side effects — typically including cramping and bleeding for several hours, according to Planned Parenthood.
Vermont law permits patients to have an abortion at any point in their pregnancy, although health department data shows 92% of abortions were performed within the first trimester. But in states where the Supreme Court’s decision in Dobbs v. Jackson Women's Health Organization has changed the legality of abortion, abortion pills can fall in a legal gray area depending on how they’re acquired.
“While we are seeing obviously a tremendous rollback in abortion access,” Baker said, there's been a “tremendous expansion of abortion access with regard to abortion pills” thanks to the availability of telemedicine.
“We're really at a stage where there's a large public awareness campaign that needs to happen so that people understand what abortion pills are, how they work, how easy they are, (and) how safe they are,” she said.