“We want to help you, but we can’t know that you’re doing mail forwarding,” said one telehealth clinician. Another summed it up concisely: “Don’t ask, don’t tell.”
U.S.-based telemedicine abortion clinicians offer consultations by videoconference, telephone or online forms and then mail abortion pills to patients to states where they are licensed and abortion is legal. Some clinicians ask patients to check a box on an online form confirming they are physically located in a state they serve, but do not confirm the patient’s physical location during the consultation.
“For example, if a clinician serves California, the patient should be in California and receiving mail in California. Now, if it’s someone who lives in Texas, and they’ve set up mail forwarding in California, or a friend is going to take that package in California and then mail it on to them, they could say something like, ‘I’m traveling to California to pick up this package.’ That’s fine, as long as it’s not blatantly obvious that they won’t be in the state where they are receiving it.
“We shouldn’t know if patients are doing mail forwarding, because it tells us that they’re not in the state where they say they are and where we are licensed,” said another clinician. “There’s too much time spent worrying about the ‘what ifs?’ instead of ‘what now?’” said one telehealth abortion clinician. “It comes down to risk tolerance. We all have different risk tolerances. The way I look at risk is, ‘What’s the worst thing that can happen if I get caught, and how likely is it?’ Those two things make me do things that a lot of people would be too nervous to do.”
While telehealth care and mail forwarding has worked for many people, several providers and Plan C report that some mail forwarding services have recently refused to forward abortion pills. “If we talk to them on the phone, we subtly tell people to use a friend rather than one of the mail forwarding places,” said the clinician.
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