'A long time coming': New medication abortion program launches on Cape and Islands

Starting today, people in rural parts of Massachusetts have more options when seeking abortions.

Although Massachusetts is among the states with the least restrictive abortion policies, advocates say there are still some regions of the state, especially the Cape and Islands, where it can be hard for people to access services, in some cases having to travel hundreds of miles to the nearest clinic, often at a high financial cost.

But through a new medication abortion program, Health Imperatives, which operates clinics in Brockton, Plymouth, Wareham, New Bedford, Hyannis, Martha's Vineyard and Nantucket, is making abortion care available in areas of the state that were previously without that service.

“Southeastern Massachusetts will no longer be considered an abortion desert,” said Julia Kehoe, CEO of Health Imperatives.

The program is funded through grants from the Massachusetts Department of Public Health. In December, right before he left office, Gov. Charlie Baker announced that the administration would award $4.1 million in grants to 11 community-based organizations to increase access to reproductive health care across Massachusetts, including abortion. That included $700,000 to Health Imperatives, which spread the grant evenly among its seven clinics.

Rep. Dylan Fernandes, who represents parts of the Cape and Islands, said the medication abortion program was "a long time coming" and that the state grant was what finally allowed it to move forward. Fernandes said he had been working with advocates and practitioners the past seven years — since his election — to try to bring abortion services to Martha’s Vineyard.

“The barriers to access [for women on Martha’s Vineyard] are similar to that in deep southern states,” Fernandes said. “So there's an incredible burden and barrier that shouldn't exist. And now, with abortion care coming to the island for the first time, that barrier's been lifted.”

Health Imperatives already provides a range of reproductive health services, Kehoe said, including pregnancy testing, cancer screening, HIV prevention and gender-affirming hormone care. They see medication abortion as the next logical step in expanding their services, regardless of the legal turmoil surrounding abortion in national politics.

“We see abortion as one missing piece of a comprehensive sexual and reproductive health care program,” she said.

Medication abortion, which differs from surgical abortion, consists of a two-pill regimen of mifepristone and misoprostol that can generally be taken up to 10 weeks of pregnancy. It has become increasingly common in recent years, and now accounts for more than half of all abortions in the United States, according to the Guttmacher Institute. Advocates say many women prefer the more private option compared to an in-clinic procedure.

With the new Health Imperatives program, a person will be able to call the office for an appointment, and come in the same day or week for abortion care. The clinics have the drugs on site, so the patient would take the first dose at the clinic and the second at home 24 to 48 hours later.

“The reason for that is we're trying to reduce all barriers to access, and to make it as easy as possible for people to get the care they need,” Kehoe said.

Access to medication abortion, even in states with few abortion restrictions, has been in legal limbo in recent months. In April, a federal judge in Texas issued a ruling that invalidated the FDA's approval of mifepristone, which has been on the market for more than 20 years. Another judge in Washington issued a dueling decision, protecting access to the drug. The Supreme Court eventually stepped into preserve access while the case makes its way through the appeals process.

Many providers in Massachusetts, including Health Imperatives, had vowed they would continue to offer medication abortion via a one-dose regimen of misoprostol if needed. In the days after the Texas judge’s ruling, Gov. Maura Healey's administration announced plans to stockpile a year’s worth of mifepristone. For the program starting this week, Health Imperatives was able to secure the drug from that stockpile, which Kehoe called a very “smooth, seamless process.”

"Medication abortion is a safe and effective method for ending a pregnancy that helps ensure access to care for people who live far away from an abortion provider or face long wait times,” Healey said in a statement to GBH News about the new program. “Our administration is committed to expanding access to reproductive health care, including medication abortion, particularly in areas like the Cape and the Islands where there are fewer abortion services available."

Kehoe said the confusion over the past year about abortion access has created a “chilling effect” and reinforced many providers’ commitments to widening access in any way they can.

“I can't underscore enough how supported we feel by the governor, the legislature and all the advocates who have made sure that people in Massachusetts can have the health care they need in their own community when they need it,” she said.