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Access to abortion varies widely for people in different parts of the country. We go from state to state.
In 1970, three years before the Supreme Court ruled Roe v. Wade enacted, Hawaii was the first state to legalize abortion. Abortion laws remain among the most liberal in the country to this day, although patients still face barriers to entry – largely due to the state’s geographic location. Maui, Oahu, and the main island all have abortion providers, who often require residents of the other five islands to purchase a plane ticket in order to legally cancel. To help Hawaiians avoid these additional costs, providers in the state have – successfully – tested drug abortion via telemedicine for eligible, more distant patients.
The fact that Hawaii allows “TelAbortion” is itself a rarity, as is the state law passed in 2006, the Roe v. Wade affirmed by banning the state from “denying”[ing] or disturb[ing] a woman’s right to choose or receive an abortion of a non-viable fetus or an abortion necessary to protect the life or health of the woman. “
The only restrictions Hawaii places on abortion are:
- Only licensed doctors or osteopathic surgeons can abort procedures. Although drug discontinuations can be performed by general practitioners such as licensed nurses
- Abortions are only legal at or after viability (~ 24 weeks) if the patient’s life or health is at risk.
How old do you have to be to get an abortion in Hawaii?
Hawaii does not have any age restrictions on access to abortion.
How Much Does an Abortion Cost in Hawaii?
The cost depends on how advanced the pregnancy is and whether you have insurance to cover it. Hawaii does not place restrictions on abortion coverage in the market or in private insurance plans, and Medicaid does cover abortion care. Before making an appointment, you can ask over the phone what the costs will be. The National Network of Abortion Funds may be able to help with the costs.
Where can you get an abortion in Hawaii?
If you look for abortion clinics in Hawaii, you’ll find three (two on Oahu and one on Maui), but there are technically more providers – there were 28 facilities in the state that offer abortions, according to a 2017 report. This is likely because there are other providers who offer abortion services to their patients but don’t accept referrals.
What is it like to seek an abortion in Hawaii?
This is a patient’s story.
Candace, unwilling to use her real name, found out she was pregnant in October 2019 after a missed time and series of unusually vivid dreams signaled her that things were wrong. “Something was just subtly telling me to check everything, and [pregnancy] was the first thing that came to mind, ”she told VICE. She took a pregnancy test, “and it sure was positive.”
After opting for an abortion, Candace, then 25, consulted her midwife and learned about a pilot abortion telemedicine program run by the Gynuity Health research group in which Hawaii is participating. After a patient has confirmed her pregnancy with an ultrasound or blood test, she can meet with a provider via video chat: the doctor will guide her through detailed instructions on how drug abortions work. If the patient has been together for less than 10 weeks, the provider may send them FDA-approved abortion pills for home use. (Ordinarily, FDA regulations prohibit shipping these drugs, but Gynuity has permission to do so as part of a clinical trial that is being conducted in 13 states. A Hawaii doctor is suing the FDA over the rules.) So far, the program has proven “Safe, Effective, Efficient, and Satisfactory,” according to a 2019 review.
This interview has been edited for length and clarity.
When did you choose to have an abortion?
I was definitely not sure for a while, and even the midwife I saw noticed to me that in her twenty years of practice she had never met anyone who took more time and energy and carefully considered all options. really weigh what the decision would be. Instinctively, I had feelings of happiness and excitement about the possibility, it was something I had always looked forward to in my life of wanting to be a mother. And then, when the reality actually impressed me, I looked at my relationship, my stability not only financially, but also where I was as my person grew. I haven’t been exactly where I would like to be to guide another person through life. It was a very emotional time to find out, and even after I made up my mind to move forward, there are still feelings of insecurity. You never know what could have been, and your mind will still linger there sometimes, but it’s definitely a very emotional thing that I didn’t take lightly.
What steps did you take to get an abortion via telemedicine?
I felt like I had a lot of flexibility because without that option I would have had to leave [the neighboring island] to see the doctor and there are other costs involved. It’s about a 40-minute air journey; At the time, prices were around $ 100 round-trip and then off-island accommodations that rented a car – that was the main cost.
While with telemedicine, I’ve been able to do everything on the island I’m on: get an ultrasound to confirm pregnancy, send the medicine to my home, and everything else from the comfort of my home Actually, a very good experience compared to what I know are the other options.
My midwife has a close relationship with the doctor who does the ultrasound here. She contacted him and said it was a time sensitive situation and I need an ultrasound asap. I think it was the next day that I had to do my ultrasound.
Did you have a consultation appointment?
You definitely need to have an appointment for telemedicine before they can send the pills to you. I had to do a video chat with [the doctor]. We were both comfortable at home and she asked me questions. I think she really wanted to make sure that with my decision I was confident that the decision I was making was reasoned and pretty much just hearing my story.
Can you tell me a little bit about the experience itself and what it was like going through it all at home?
You take one pill and a second pill 24 hours later. I know a lot of people get symptoms and side effects [the first one];; Personally, I didn’t. It was more of a waiting game and when I took the second I had a lot of severe cramping, extreme bleeding, which I would call a very heavy period, within hours. There is some pain, just with the cramps.
Fortunately, I had a good friend who supported me throughout my process. It was perfect when I felt at home. I had to plan it, I had everything I needed, I had a heating pad, I had food and my friend was there to comfort me. If I needed anything, I knew she was in the other room, but I was in the bathroom all night letting it all happen. There was definitely a lot of persistent bleeding the next day or days after, but you could tell that the severity of the night I took it had gotten through the pregnancy.
[For follow-up] You have two options to confirm that the termination was successful: you can either do a blood test or an ultrasound, and I chose to have the ultrasound. My doctor noticed that something very small was left behind [in the uterus] but it didn’t matter, it was something he assumed would later pass. [The abortion] was rated as a success.
Do you remember how much the procedure cost? If you were insured at the time, did the insurance cover any of this?
I was insured at the time and don’t think I paid anything out of my own pocket for the whole thing.
Would you like to comment on this experience?
Telehealth is a great option. I am very grateful that this is the path that I could go. It gives people more independence and a sense of control over the situation. In a way, you’re already giving up so much, and if you at least have the opportunity to do it yourself, some people might want to be guided by a doctor, but it was almost more empowering for me to know, okay, I’m doing this in in my time. It gave me more freedom, the whole experience. Freedom and the ability to really dictate how it would go on.
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