In 1970, three years before the Supreme Court handed down its landmark Roe v. Wade decision, Hawaii became the first state to legalize abortion. Today, its abortion laws remain among the country’s most liberal, although patients still face access barriers—chiefly because of the state’s geography. Maui, Oahu, and the main island all have abortion providers, often obligating residents of the five other islands to buy a plane ticket in order to terminate legally. To help Hawaiians route around that added expense, providers in the state have been—successfully—testing medication abortion via telemedicine for eligible, farther-flung patients.
That Hawaii permits “TelAbortion” is itself a rarity, as is the state law enacted in 2006 that affirms Roe v. Wade by barring the state from “deny[ing] or interfer[ing] with a female’s right to choose or obtain an abortion of a nonviable fetus or an abortion that is necessary to protect the life or health of the female.”
The only restrictions Hawaii places on abortion are:
- Only licensed physicians or osteopathic surgeons can perform procedural abortions; although medication abortions can be administered by advanced practice clinicians like registered nurse practitioners
- Abortions are only legal at or after viability (~24 weeks) when the patient’s life or health is endangered.
How old do you have to be to get an abortion in Hawaii?
Hawaii does not place any age restrictions on abortion access.
How much does it cost to get an abortion in Hawaii?
Cost depends on how far along the pregnancy is and whether or not you have insurance that will cover it. Hawaii does not place any abortion-coverage restrictions on marketplace or private insurance plans, and Medicaid covers abortion care. You can ask on the phone before scheduling an appointment what the cost might look like. The National Network of Abortion Funds may be able to help with the cost.
Where can you get an abortion in Hawaii?
If you search for abortion clinics in Hawaii you’ll find three (two on Oahu and one on Maui), but there are technically more providers—as of a 2017 report, there were 28 facilities providing abortion in the state. That’s likely because there are other providers who offer abortion services to their patients, but do not accept referrals.
What is it like seeking an abortion in Hawaii?
This is one patient’s story.
Candace, who didn't want to use her real name, found out she was pregnant in October 2019, after a missed period and a series of unusually vivid dreams signaled to her that things were off. “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 sure enough, it was positive.”
Once Candace, then 25, decided to get an abortion, she consulted her midwife, and found out about a telemedicine abortion pilot program run by the research group Gynuity Health in which Hawaii participates. After a patient confirms their pregnancy via an ultrasound or a blood test, they can meet with a provider via video chat: the doctor walks them through detailed instructions on how medication abortion works. If the patient is fewer than 10 weeks along, the provider can then ship them FDA-approved abortion pills for use at home. (Ordinarily, FDA regulations bar these drugs from being shipped but Gynuity has permission to do so as part of a clinical trial, which operates in 13 states. A Hawaii physician is suing the FDA over the rules.) So far, the program has proved “safe, effective, efficient, and satisfactory,” per a 2019 review.
This interview has been edited for length and clarity.
When did you decide to get an abortion?
I was definitely not certain in my decision for some time, and even the midwife I was seeing noted to me that in her twenty-some years of practice, she’s never met anyone who took more time and energy and thoroughly considered all of the options, really weighing out what the decision was going to be. Instinctively, I had feelings of happiness and excitement because of the possibility, it was something I’d always looked forward to in my life, wanting to be a mother. And then when the reality actually struck me, I was looking at my relationship, my stability not only financially, but also where I was at with the growth of myself as an individual. I wasn’t exactly where I’d like to be in terms of guiding another person through life. It was a really emotional time, figuring that out, and even after I decided to move forward, there’s still feelings of uncertainty. You never know what could’ve been, and your mind will still linger there sometimes, but it’s definitely a very emotional thing that I did not take lightly.
What steps did you take to get an abortion via telehealth?
I felt like I had a lot of flexibility, because without that option, I would’ve had to go to [the neighboring island] to see the doctor, and there are other expenses involved in doing that. It’s about a 40-minute plane ride; at that time, prices were about $100 round trip, and then accommodations on the other island, renting a car—those were the main expenses.
Whereas with telehealth, I was able to do everything on the island where I’m located: going to get an ultrasound to confirm the pregnancy, and having the medicine mailed to my house and doing everything else from the comfort of my home, which was actually a very good experience in comparison to what I know the other options are.
My midwife has a close relationship with the doctor who does the ultrasounds here, so she contacted him and said it was a time-sensitive situation and that I needed an ultrasound as soon as possible. I believe it was the next day I got to go and get my ultrasound done.
Did you have a counseling appointment?
You definitely have to have the telehealth appointment before they’ll make any move in terms of sending you the pills. I had to do a video chat with [the doctor]. We were both in the comfort of our homes, and she asked me questions. I think she really wanted to ensure that I was confident with my decision, that there was rationale behind the choice that I was making, pretty much just hearing my story.
Can you tell me a little bit about the experience itself and what it was like going through all of it at home?
You take a pill and then 24 hours later, you take a second pill. I know a lot of people do get symptoms and side effects from [the first one]; I personally did not. It was more of a waiting game, and once I took the second one, within a few hours I had a lot of heavy cramping, extreme bleeding, which I would describe as a very heavy period. There is some pain involved, just with the cramping.
Thankfully, I had a good girlfriend who supported me all the way through my process. Being in the comfort of my home, it was perfect. I got to plan for it, I had everything I needed, I had a heating pad, I had food, and my friend there to comfort me. If I needed anything, I knew she was there in the other room, but I was in the bathroom for a lot of the night, letting it all pass. The next day, or days after, there was definitely a lot of continual bleeding but you could tell that the heaviness the night that I took it had passed the pregnancy.
[For follow-up] you have two options to confirm that the termination was successful: you can do either a blood test or an ultrasound, and I opted to do the ultrasound. My doctor did note that there was a very small something left behind [in the uterus] but it wasn’t anything of concern, it was something he assumed would later pass. [The abortion] was deemed a success.
Do you remember how much the procedure cost? If you had insurance at the time, did insurance cover any of it?
I had insurance at the time, and I don’t believe I paid anything out of pocket for the entire thing.
Anything else you’d like to say about the experience?
Telehealth is a great option. I’m very grateful that this is the route that I was able to take. It gives people more independence and a sense of control over the situation. You’re already giving up so much, in a sense, and if you at least have the ability to do this on your own—some people maybe want to be guided by a doctor, but for me, it was almost more empowering to know, Okay, I'm doing this on my time. It gave me more freedom, the whole experience. Freedom and the ability to really dictate how it was going to go.
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This article originally appeared on VICE US.