Mifepristone is an abortion pill that is used in nearly two-thirds of abortions in the United States. It’s safe. It’s effective. And it’s become a top target for anti-abortion advocates.
Although the U.S. Supreme Court rejected an attempt to completely ban mifepristone in 2024, attacks on the medication have continued. Now, multiple lawsuits have settled on a singular focus: blocking access via telehealth.
Why this approach? Since the fall of Roe v. Wade, telehealth has become a much more common way to access abortion health care.
Globally, prescribing mifepristone via telehealth is standard practice. In the United States, the Food and Drug Administration (FDA) has formally authorized it since 2023, allowing providers to prescribe the medication through virtual visits and dispense it through in-person and mail-order pharmacies.
Telehealth access is beneficial for patients in many different circumstances, but it is especially important for survivors of intimate partner violence. In some cases, it can be a matter of life and death.
Here’s why.
What is intimate partner violence?
Intimate partner violence (IPV) refers to abuse or aggression in romantic relationships. It is generally a pattern of behaviors used to exert power and control over a current or former partner.
That control can take many forms. Abusers may:
- isolate survivors from friends and family
- monitor their movements, communications, and relationships
- restrict access to money or employment
- track transportation and limit time away from home
- threaten to harm or kidnap children
How common is intimate partner violence?
Intimate partner violence is a widespread public health crisis in our society. Nearly 60 million women in the United States report that they have experienced sexual violence, physical violence, or stalking by an intimate partner during their lifetimes.
No community is immune from intimate partner violence, but women of color, women living in poverty, and undocumented immigrants experience disproportionately high rates of abuse.
- 54% of Black women, 58% of Native women, and 64% of multiracial women report experiencing IPV, compared 48% of white women (48%).
- Rates of intimate partner violence are disproportionately high for Asian and Latina immigrant women because they face additional barriers to safety, including language difficulties, immigration status, and fear of the legal system.
- Women living in poverty are nearly twice as likely to experience domestic violence.
How does intimate partner violence impact reproductive health?
Abusers frequently use “reproductive coercion” to control their partners.
They may throw out and damage contraceptives, remove condoms during sex without consent, forcibly remove internal-use contraceptives, retaliate against their partners for using contraceptives, and coerce their partners into having an abortion or not having an abortion.
The stories of the survivors who have faced reproductive coercion are harrowing and can best be understood through their own words. Here are just three collected by the National Domestic Violence Hotline:
My partner knowingly and forcefully kept having sex after [my] consent was withdrawn. I became pregnant as a result of rape. I was raped again once I discovered I was pregnant while I was in an incredibly vulnerable state. After the first rape, I wanted to go to the pharmacy as soon as possible to get the morning-after pill. However, I had no way of getting there and feared trying to go on my own, of what he would have tried to do if I left. I had to wait until he took me, which was well over the amount of time I wanted to go, and obviously, the pill by this point was ineffective, as I became pregnant as a result.
My husband has taken my birth control because he told me it was making me gain weight. He has come with me to ob-gyn appointments expecting to talk to the doctor about my birth control. He has cheated multiple times and forced me to continue to have unprotected sex.
My former partner refused to allow me the recommended six-week post-partum recovery period of no penetration after the birth of our first child. He warned me when I got out of the hospital that he would not hold off on having sex for six weeks, so I needed to get that notion out of my head. Two weeks after giving birth, he initiated penetration with no discussion or permission while we were in bed for the night. Since my pregnancy and onward, he had become more violent and refusing sex was not an option for me. I did not begin birth control immediately after birthing my first child. I was in survival mode and looking for the first opportunity to escape from my abusive partner, hopefully with my baby. I did not know how he would respond to me being on birth control. After a couple of months of unprotected sex, I did not know if I was pregnant again and was afraid to start birth control if I was.
Why is abortion care so important to survivors of intimate partner violence?
For survivors of intimate partner violence, especially those whose unintended pregnancies resulted from reproductive coercion, access to abortion is critical.
1. Pregnancy increases health risks for survivors.
Abusers commonly interfere with medical care by restricting access to transportation and refusing to make co-payments or provide insurance.
As a result, survivors are less likely to receive prenatal care and more likely to miss doctors’ appointments, all of which jeopardizes their health. Even when survivors can travel for appointments, abusive partners can manipulate conversations with providers to conceal abuse. Survivors are at a high risk of depression and post-traumatic stress disorder, and some face an increased risk of having babies preterm and babies with low birth weight.
2. Violence often escalates during pregnancy.
Pregnant people in abusive relationships are likely to suffer more, and more intense, violence during pregnancy. Every year, intimate partner violence affects as many as 324,000 pregnant women.
That violence often escalates to homicide. In fact, homicide is the leading cause of death for pregnant women in the United States.
3. Forced Pregnancy Can Trap Survivors in Abuse
If a survivor goes on to have a child with the abuser, it becomes even harder to leave the relationship. Finding housing becomes harder, arranging transportation becomes harder, and survivors must face the added cost of child care. Additionally, survivors with children must navigate the legal system to obtain custody and ensure protective parenting arrangements, usually without legal advice or representation.
To make matters worse, violent partners have learned to use this system to their advantage. Nationwide, abusive fathers are more likely to seek child custody than non-abusive fathers, and they succeed more than 70% of the time.
Why is it important for survivors to access abortion care through telehealth?
Accessing in-person care often requires navigating a maze of logistics — transportation, child care, and time off work — all while avoiding an abuser’s scrutiny. And for many survivors, that’s simply impossible.
On the other hand, telehealth makes care feasible. When survivors can see a doctor virtually, pick up prescriptions at local pharmacies, and receive medication in the mail, they have the power to protect their privacy.
Indeed, in-home medication abortion is often their only way to move forward without risking their lives.
What Legal Voice is Doing
Legal Voice has advocated for survivors of intimate partner violence and access to reproductive health care since its founding in 1978.
In recent years, we filed friend-of-the-court briefs urging the Montana Supreme Court and the U.S. Supreme Court to safeguard access to abortion.
Currently, we are advocating for survivors in State of Louisiana v. FDA, a case that threatens telehealth access to mifepristone nationwide. Alongside the National Domestic Violence Hotline, National Network to End Domestic Violence, Ujima: The National Center On Violence Against Women in the Black Community, the Center for Survivor Agency and Justice, and leading researchers, we are ensuring that courts understand what is at stake.
What You Can Do
- Join Legal Voice’s email newsletter to stay informed about the fight for gender justice in the Northwest.
- Contact us to learn how you can host a know-your-rights event at your organization or community center. Legal Voice staff are available to give free educational presentations in Washington, Idaho, and Montana.
- Consider donating to Legal Voice, your local abortion fund, or an independent abortion clinic near you.
Resources
- Legal Voice has a free, online resource library that covers a variety of topics related to intimate partner violence and reproductive health.
- If you are experiencing reproductive coercion, you can reach the National Domestic Violence Hotline at 800-799-SAFE(7233).
- For legal assistance, you can reach the If/When/How Repro Legal Helpline at 844-868-2812.
