Women bypass Florida’s 6-week abortion ban through telehealth, mail, travel

In the month since Florida imposed a six-week abortion ban, Lana’e Hernandez has helped nearly 200 women figure out how to end later pregnancies, work that sometimes means securing airfare, hotel rooms and money to pay clinics in places as far away as Illinois.

Her clients have included a first-time mother who terminated a pregnancy due to serious fetal health defects and a single mother of five unable to support another baby. She said some of her clients have never left the state before, or flown on a plane.

“This very well may be one of the most difficult decisions our patients have ever had to face in their life, and our government has put them in a position where they need to leave their support system and travel across the country and incur massive expenses,” Hernandez said. “I wish I could just be at the airport and walk them to their gate.”

Hernandez’ experiences underscore the many ways Florida’s new abortion rules have made it more difficult for women and health care providers grappling with the question of how to end a pregnancy.

While some women are traveling, others are using telehealth appointments with out-of-state doctors to obtain abortion-inducing medication. Their decisions are fraught with emotion and logistical difficulties — and it is unclear how long these options can be sustained in the face of financial and legal challenges.

Hernandez has a window on the issue as a patient navigator for Planned Parenthood of Southwest and Central Florida — a job that has become increasingly common since the U.S. Supreme Court overturned the constitutional right to abortion in 2022. Fourteen states now ban it outright, with limited exceptions. Three states, including Florida, ban it six weeks from the first day of a pregnant woman’s last period, with few exceptions.

Florida had a 15-week ban on abortions in place since 2022 and prior to that allowed them until 24 weeks.

Since Florida’s new ban took effect on May 1, some women have managed to get abortions within the state’s cutoff, providers say, while some who don’t know they’re pregnant until after six weeks have chosen to continue with unwanted or dangerous pregnancies.

State abortion data for May is not yet complete, so the exact impact of the new rule is not clear.

The November election could also change abortion access. Residents will be asked to vote on Amendment 4, which would make abortion constitutionally protected in Florida up to viability — about 24 weeks — if 60% of voters say yes.

Navigating new restrictions

Supporters of Florida’s six-week ban say they are confident it will sharply reduce the number of abortions obtained by state residents, despite efforts to evade it.

“In the vast majority of cases, by far, this is going to have a big impact, as it has in other states,” said Mat Staver, founder of the pro-life Liberty Counsel. “Florida will not be an abortion destination as it was prior to this law.”

Florida medical providers performed over 84,000 abortions last year, including nearly 8,000 for people who traveled from out-of-state.

Organizations called abortion funds aim to help women circumvent state bans. In 2023, these funds provided over $36 million for abortions and over $10 million for logistical support nationwide, according to the National Network of Abortion Funds.

But rising costs have made it impossible to fully meet the need, said Stephanie Loraine Piñeiro, executive director of the Florida Access Network abortion fund, at a press conference hosted by the national network on Monday.

“Florida’s ban forces Floridians and people across the southeast to travel further, exhausting funds for travel and practical support even faster,” Piñeiro said.

Piñeiro said her fund has helped 150 people over the last month, but the fund can only cover about 50% of requested expenses on average.

Telehealth support

Dr. Ushma Upadhyay, a professor at the University of California San Francisco’s Advancing New Standards in Reproductive Health, believes that because of the new restrictions many women in Florida have obtained or will obtain abortion-inducing pills online.

Under current law, that’s a viable option, but overlapping rules make the situation complicated. While the state bans telehealth prescribing for abortion medication, the ban applies to doctors, not the women themselves.

Certain states have passed “shield laws” that aim to protect licensed clinicians in that state from prosecution for prescribing abortion pills to people in states where it’s illegal. Online pharmacies then fill and mail these prescriptions.

Nearly 8,000 people per month in states with bans or restrictions on abortion are prescribed and mailed abortion pills under shield laws, according to estimates from The Society of Family Planning’s #WeCount project, a national abortion reporting effort. One of the largest providers, Aid Access, charges $150 or less.

“Telehealth really removes so many barriers to abortion,” said Upadhyay, who is also a #WeCount co-chair. “Patients don’t even have to take time off work or find childcare.”

Currently, Florida women who terminate their pregnancy this way aren’t facing prosecution, nor are the people who help them. Gov. Ron DeSantis has previously said pregnant women who get abortions in violation of Florida’s law won’t be criminally charged, in line with a previous state supreme court ruling.

The telehealth prescription movement alarms people who support abortion bans, however. Liberty Counsel’s Staver is “optimistic” this practice will be outlawed in the future.

“I think it’s a major concern,” Staver said. “It makes no sense for … Florida to pass a law that regulates brick and mortar facilities, yet at the same time, someone intentionally sends medication into Florida that is specifically designed to violate the law.”

The U.S. Supreme Court on Thursday issued a ruling preserving access to the medication mifepristone, which is used in many abortions, but other legal challenges are expected.

Dr. William Lile — a North Florida obstetrician and gynecologist who calls himself the “ProLife Doc” and believes life begins at conception — said he’s concerned about the health of women who get pills without in-person testing to confirm how far along their pregnancy is and to rule out conditions such as ectopic pregnancy.

The condition, when a fertilized egg grows outside the uterus, is rare but can be life-threatening. A ruptured ectopic pregnancy causes similar symptoms to an abortion, so women who take the pill may not realize what’s really happening, he said.

“We’ve already had cases of women who have been harmed,” Lile said. “They thought they were taking the pill for an abortion, yet in reality, they were in that 1% that had an ectopic pregnancy and it is delaying them from seeking health care.”

These pills are generally safe to take up to 10 weeks into pregnancy, according to the U.S. Food and Drug Administration, which notes that though side effects are common, serious adverse reactions are rare.

Impact on Florida clinics, patients

Not everyone can travel or obtain pills, however. The ban has hit some women hard.

Researchers at Middlebury College estimate that the average Florida resident now lives nearly 600 miles from the nearest clinic that offers abortions after six weeks, up from an average of 20 miles before the ban. Wait times for appointments have increased at about 30% of clinics in North Carolina, Virginia, Maryland and Washington, D.C., the closest states where abortion is legal after six weeks of pregnancy.

“I’m hearing people say, ‘Well, yeah, I got [an abortion], but I went to Georgia first, and then I went to Ohio, and some of my rent isn’t paid, and I don’t know where I’m going to live,” said Jenice Fountain, executive director of Alabama’s Yellowhammer Fund, during Monday’s press conference. “That’s not a win.”

Dr. Robyn Schickler, chief medical officer of Planned Parenthood of Southwest and Central Florida, said some women, aware of the new law, quickly make appointments and get abortions within the new legal timeframe. Others can take the time, and pay at least some of the costs, for an out-of-state trip.

But she’s haunted by the patients who she can’t help.

“No matter how much you try and help, some patients, for a variety of reasons, can’t leave. These are the most disadvantaged, vulnerable individuals forced to continue their pregnancies,” Schickler said.

Ccatherman@orlandosentinel.com