“I don’t want to be in the energy of that situation”: Embodied experiences with telehealth medication abortion

Abstract

Medication abortion makes up the majority of abortions in the U.S. today. Use of medication abortion by telehealth, in which the entire abortion process occurs remotely, has also grown in recent years. In this study, we examine embodied experiences of telehealth abortion through 30 in-depth interviews. We explore how participants’ preferences for telehealth medication abortion and their assessment of a successful abortion were informed by embodied sensations and experiences. Importantly, we find that stigma influences embodied experience of telehealth and that many telehealth patients want to avoid embodying the abortion patient in a clinic. We conclude by calling on providers and policymakers to examine embodied aspects of abortion and how the sociocultural context surrounding abortion impacts not only the physical experience of abortion but also patient preferences for delivery of care.

1. Introduction

Abortion is an inherently bodily experience that can entail physical sensations like pain, cramping, and bleeding. It is also an extremely common bodily process: one in four pregnant people in the United States will have an abortion in their lifetime (Jones, 2024) and the majority of these are medication abortions (Jones & Friedrich-Karnick, 2024). While a robust body of literature has examined people’s experiences of abortion, including decision-making and care-seeking (for notable exceptions see e.g., Aiken et al., 2018; Kimport, 2022; Lafaurie et al., 2005; Upadhyay et al., 2022), less literature has engaged the framework of embodiment to understand people’s lived experiences with different models of abortion care (for notable exceptions see e.g., Kimport & Littlejohn, 2021; Purcell et al., 2017). Even less is known about embodied experiences with telehealth medication abortion, a recent innovation in abortion care in the United States due to new regulatory changes introduced in 2021 during the height of the COVID-19 pandemic (Baker, 2023; Upadhyay et al., 2021). In a telehealth medication abortion, the entire abortion takes place remotely; patients complete an online intake form and/or meet with clinicians during virtual appointments to assess medical eligibility, and the medications are shipped to the patient’s home. Extant research shows that telehealth medication abortion mitigates the structural barriers to in-person abortion—often in the form of travel, costs, and logistical hurdles (Aiken, et al., 2019; Becker, 2023). Such barriers have existed long before the Dobbs v. Jackson Women’s Health Organization 2022 decision (Cartwright et al., 2018) and can heighten feelings of shame, stress, and stigma (Becker, 2023).

In this article, we build on this growing body of work through in-depth interviews with people who had telehealth medication abortions between June 2021 and January 2022, prior to the Dobbs decision. In the wake of the overturning of Roe v. Wade, people seeking abortion are increasingly relying on home abortion delivery methods including telehealth (25% of abortions are now telehealth) (Society of Family Planning, 2025). Contributing to this trend is the rise of new shield laws that offer certain protections to providers who choose to prescribe abortion pills to patients in states with bans (Cohen et al., 2023). Amid this increased demand, it is critical to examine peoples’ embodied experiences with telehealth medication abortion and how one’s social context shapes these bodily experiences. In our analysis, we find that stigma shapes the embodied experience of telehealth abortion, as well as how preferences for telehealth medication abortion over in-person medication or procedural abortion are informed by embodied perceptions of pain, invasiveness, and emotion. Moreover, we highlight a desire to avoid embodying the abortion patient, which refers to the stigmatized experience of physically occupying the role of “abortion patient” in a clinic. We conclude by calling on researchers, policymakers, and providers to account for the embodied aspects of abortion, and how the sociocultural context surrounding abortion impacts not only the physical experience of abortion, but also patient preferences for delivery of care, and patient perceptions of a complete at-home abortion.

1.1. Medication abortion and telehealth

Medication abortion is highly common; medication abortion accounted for 63% of all abortions in the formal health care system in the United States in 2023 (Jones & Friedrich-Karnick, 2024). Medication abortions typically involve the administration of mifepristone followed by misoprostol and is typically offered up to 11 or 12 weeks of pregnancy duration, though can be used safely and effectively throughout pregnancy (World Health Organization, 2023). A robust body of literature has found medication abortion to be safe and effective, providing an alternative to procedural abortions (Kapp & Lohr, 2020; Upadhyay et al., 2015). In the United States, medication abortion can be accessed in-person through brick-and-mortar clinics, doctors’ offices, or hospitals, remotely from brick-and-mortar clinics that offer telehealth services, or remotely from virtual clinics which offer telehealth services only, where the medication is prescribed by a certified clinician (FDA, 2023). In some cases, after a clinician prescribes the medications, they can be picked up at a pharmacy. Individuals may also access abortion medications via online sources without the involvement of a clinician. This type of self-managed abortion takes place outside of the formal healthcare system, while telehealth medication abortion involves remote provision of medication abortion by a licensed clinician. Whether the patient picks up the medications from a clinic or pharmacy, or receives them by mail, the patient will expel the pregnancy at home.

While telehealth medication abortion is relatively new to the United States, remote self-managed abortion care has long served as a strategy to access abortion in legally restrictive settings around the world (Aiken et al., 2017; Drovetta, 2015; Gomperts et al., 2014; Moseson et al., 2023). Virtual abortion hotlines and organizations such as Women on Web have contributed to a substantial body of evidence supporting the safety and efficacy of remote care models, which paved a path for telehealth medication abortion models in the United States, particularly after the COVID-19 pandemic (Aiken, Starling, Gomperts, Scott, & Aiken, 2021). Prior to COVID-19, medication abortion in the United States could only be accessed in clinics, doctor’s offices, or hospitals, either with a face-to-face interaction with a clinician, or with a clinic-to-clinic telehealth model due to a requirement of the FDA’s risk evaluation and mitigation strategy (REMS) that the medications be dispensed in-person. In 2021, the FDA updated the REMS regulation of mifepristone, removing the in-person dispensing requirements, and the use of virtual abortion clinics in the U.S. expanded. These regulatory changes, coupled with the reversal of Roe v. Wade in 2022 which resulted in numerous clinic closures in banned states as well as longer wait periods in protected-access states, have resulted in an increased demand for abortion care beyond brick-and-mortar clinics (Society of Family Planning, 2025). Moreover, new shield laws in abortion-supportive states offer certain legal protections to clinicians who provide telehealth abortion to patients in states with abortion bans; accordingly, the use of telehealth abortion is growing rapidly, reaching 25% of all abortions in the U.S. as of December 2024 (Society of Family Planning, 2025).

A growing body of literature has explored people’s experiences of telehealth medication abortion. For many people seeking abortion, telehealth provides a safe, convenient, and efficient way to access abortion care (Kerestes et al., 2021; Koenig et al., 2024; Upadhyay et al., 2024). Indeed, access to telehealth medication abortion has been shown to remove numerous barriers to abortion care, such as travel time to clinics and the need for childcare (Becker, 2023; Thompson et al., 2022; Koenig et al., 2023). For instance, in a study by Koenig et al. (2023), telehealth made accessing a timely abortion easier for patients who lived in rural areas, and for those experiencing other structural issues such as food insecurity. While this literature has established the distinct benefits that telehealth services offer, few of these studies have examined the embodied experiences of individuals seeking telehealth medication abortion.

1.2. Embodiment of reproductive healthcare

Embodiment is a foundational concept in social science literature that theorizes how the body and bodily sensations are both shaped by the social environment and inform one’s perception of the outside world (Krieger, 2005). Specifically, the term “embodiment” can be understood as experiencing and perceiving the world through one’s body (Jackson & Scott, 2014; Krieger, 2005; Tolman et al., 2014). Indeed, social scientists have found that the social world greatly impacts experiences with healthcare interventions. This is particularly the case within reproductive healthcare, as this area of medicine tends to be fraught with stigma as well as gendered and racialized stereotypes. Amid this social back-drop, cultural and structural elements influence the way patients both perceive and physically experience reproductive healthcare practices, as well as the way they describe the embodied elements. For example, in the case of hysterectomy, a patient’s race and gender, as well as the perceived agency they felt in choosing the procedure, influence the emotional and embodied reaction to this surgery (Becker, 2023). In terms of childbirth, perceptions of vaginal birth as more “natural” influence the type of birth patients want, and how they feel about their birthing experience (Brubaker & Dillaway, 2009; Malacrida & Boulton, 2012). This research has found that birthing people tend to view C-sections as a failure to fully accomplish their “rite of passage” to motherhood (Malacrida & Boulton, 2012), highlighting how embodied experiences of birth are shaped by social forces, including normative ideals of gender and motherhood. While people of various genders, including trans men and nonbinary people, experience reproductive healthcare like abortion, hysterectomy, and birth, cultural stigmas associated with “women’s bodies” in particular impact the experience, necessitating a gender analysis that accounts for the role of femininity, womanhood, and sexism, while being trans-inclusive.

A growing body of research has explored the embodied experiences of medication abortion, highlighting the physical and sensorial aspects of abortion (Alam et al., 2020; Arey et al., 2023; Lafaurie et al., 2005; Purcell et al., 2017), the psychosocial and emotional responses (Aiken, et al., 2019), and the ways in which these embodied experiences are shaped by broader social and structural forces (Broussard, 2020; Love, 2021). For instance, one study conducted in Ireland found that structural abortion stigma influenced the embodied experience with medication abortion; the majority of this sample preferred medication abortion to procedural abortion, because it is more “natural” and similar to a menstrual period, despite the often-intense pain of the procedure (Broussard, 2020). In a study in Mexico, women preferred to begin their medication abortion experience in a clinic, as they felt “peace of mind” in that environment (Amuchástegui, 2013). However, in a recent study conducted in a U.S. context, we found that many telehealth abortion patients prefer the privacy that telehealth offers and felt more comfortable at home—even in some instances when an in-person abortion would have been financially and geographically accessible (Becker, 2023). The present study builds on this work by examining the embodied experiences of medication abortion by telehealth. We interrogate how people who had telehealth medication abortions describe their preferences for telehealth and how they determine a complete abortion (meaning, the pregnancy is successfully terminated), highlighting how both are shaped by embodied sensations. In the process, we examine how a broader social structure—namely, abortion stigma—influences embodied experiences of telehealth medication abortion.

2. Methods

This study draws on 30 in-depth interviews conducted with individuals who had a telehealth medication abortion between June 2021 and January 2022, prior to the Dobbs decision. Interview participants were purposively sampled from a larger longitudinal study—the California Home Abortion by Telehealth (CHAT) study—which evaluated the safety, effectiveness, and acceptability of telehealth medication abortion provided by three private, for-profit virtual telehealth clinics: Abortion on Demand, Choix, and Hey Jane (Koenig et al., 2023, 2024a; Upadhyay et al., 2024). These telehealth services provided fully remote, synchronous (video) and/or asynchronous (secure messaging) medication abortion care from licensed clinicians and ranged in price from $199 to $289. At the time of this study, none of these telehealth clinics accepted insurance, but they did offer financial assistance from abortion funds. These virtual clinics served a combined 20 states in the United States and Washington, D.C. Among the three virtual clinics, patients were generally eligible to receive medication abortion services if their pregnancy duration was less than 70 days (assessed by date of their last menstrual period or by ultrasound) and if they provided a mailing address in a state where the virtual clinic was operational. Only one virtual clinic (Choix) served patients under 18 years old, only in California, and did not require parental consent or notification consistent with state law. Once the patient’s medical eligibility was assessed and approved by a licensed clinician, they received the medications via mail-order pharmacy. Patients also received follow-up messages from licensed clinicians via secure text message or phone.

2.1. Sample

Thirty interview participants were recruited from the larger longitudinal study. In a previous stage of the CHAT study, we conducted three longitudinal surveys with 1600 individuals who had obtained a telehealth medication abortion: a baseline survey at abortion intake, a second survey one week after intake, and a final survey four weeks after intake. Individuals were eligible to participate in an interview if they had completed the series of longitudinal surveys and agreed to be contacted again in the future regarding an interview, resulting in a sampling frame of 1260 individuals. From this sample, 119 individuals were invited to participate in an interview via their preferred method of communication, including emailing or texting, as indicated in the prior survey. We utilized a purposive sampling method to account for a diverse interview sample. In particular, we stratified the participants by race/ethnicity, age, and those who experienced an adverse event and randomly selected participants using a random number generator to recruit from each stratum until the sample was complete.

Participants ranged in age from 16 to 39, with an average age of 27, and five participants were adolescents (18 years or younger). Two of these adolescents were under the age of 18 at the time of their abortion, and both lived in a state that did not require parental consent or notification. The sample had a diverse racial and ethnic makeup, with nine identifying as non-Latinx white, six as Asian or Pacific Islander, five as Black, five as Latinx, and five as multiracial. We purposively over-sampled three participants (10% of our interview sample) who reported requiring additional medical care after taking abortion medications. This was to ensure the inclusion of experiences of reported adverse events, even though the adverse event rate of medication abortion has been found to be only 2% (Upadhyay et al., 2024). Slightly over half of the interview participants (n = 16) used an asynchronous telehealth medication abortion service, in which all of their communication was conducted via a secure messaging platform, while 14 participants used a synchronous service that had elements of live video communication. Importantly, all participants in the sample accessed care from providers in abortion-supportive states at the time of their telehealth medication abortion. Participant names have been changed throughout the manuscript to protect their identities.

2.2. Procedures

All procedures were reviewed and approved by the University of California, San Francisco’s institutional review board prior to beginning data collection. Interviews were conducted remotely via Zoom by the first, second, and third authors between July and September 2022. Although the interviews took place after the Dobbs decision, the questions pertained to participants’ telehealth medication abortion experiences prior to the Dobbs decision. The interviews lasted between 40 and 90 min. Prior to beginning the interviews, participants provided informed consent for participation in the interview and audio recording. The interviews followed a semi-structured interview guide of 20 questions that addressed factors that contributed to participants’ decision to choose telehealth medication abortion and their overall abortion experience. Sample interview questions included: “Can you tell me about your experience taking the abortion medications?”; “Did you consider a brick-and-mortar clinic?”; and “How did you know that the medications were working?” Interviews were audio recorded via Zoom and transcribed verbatim. Participants were compensated with a $50 electronic debit card for their participation.

2.3. Analysis

Thematic analysis was guided by a flexible coding approach, which is a transparent method of qualitative data analysis that utilizes both inductive and deductive approaches to coding and theory development (Deterding & Waters, 2018). The first and second authors coded the data using Dedoose, a computer-assisted qualitative data analysis software. The authors began with a deductive approach by developing a codebook that aligned with broad themes that were addressed in the interviews. Example codes included “feelings about abortion” and “abortion experience.” To allow for an inductive approach, the authors also identified emergent and in-vivo codes from the transcripts. Existing codes were refined on an ongoing basis. Throughout the process of data analysis, the concept of embodiment emerged as an unexpected and important factor in understanding overall experiences of telehealth. Once the overarching theme of “embodied experiences” was selected, the first and second authors conducted secondary, analytic coding to identify key sub-themes (e.g., “embodying abortion patient; ” “successful abortion”). Discrepancies in coding were discussed by the research team to ensure congruence during the data analysis process.

3. Findings

Participants in this study described various ways in which their abortion experiences were embodied—or not embodied. A common theme threading the various accounts was opting for a telehealth abortion out of a desire to avoid embodying an abortion patient in a clinic and the various embodied elements required, including an examination, a sonogram, an in clinic procedural abortion, or simply being physically present in a clinical space as an abortion patient. However, the experience of a medication abortion at home is also embodied through the physical symptoms of the abortion as well as the visual encounters with aborted pregnancy tissues (which are material elements of the body). Moreover, reduced interactions with clinicians (as is part of telehealth medication abortion) and gaps in abortion knowledge led to increased embodied discomfort for some. Below, we highlight the following themes: (1) avoiding embodied presence in abortion clinics; (2) embodied preference for telehealth medication abortion; and (3) participants’ assessment of completed abortion. Participants’ preferences for telehealth and their assessment of abortion completion were informed by embodied sensations, ranging from a desire to avoid a more “invasive” clinical settings and abortion procedures to a reliance on bodily sensations like diminishing pregnancy symptoms to determine completion. Of note, there is an overlap between embodied experiences with medication abortion generally and experiences of medication abortion via telehealth. Throughout, we will present participant descriptions of both aspects of their abortions—the use of medications and provision through telehealth—while illustrating the ways in which telehealth adds an additional layer of meaning to their medication abortion experiences.

3.1. “That makes my skin crawl:” Avoiding embodied presence in abortion clinics

In line with embodiment literature on how social forces influence bodily processes (Krieger, 2005), participants’ preferences were shaped by structural abortion stigma (Becker et al., 2025). In particular, many preferred telehealth as it allowed them to avoid encountering potentially stigmatizing situations in or outside of a clinic. Carla, a 32-year-old Latina in Colorado who used a synchronous service, shared:

Having it be online just made it a little bit more comfortable, I guess is the only word that kind of comes to mind … I guess just having, I don’t know, there’s so much stigma around the abortions in general, and I think that both my husband and I just felt like it was the right thing for our family.

For Carla and others in our sample, a telehealth abortion is simply more “comfortable” amid widespread stigma—on the enacted, felt, and internalized levels of abortion stigma (Herek et al., 2015). As we will elaborate in the following subsections, this comfort regarded embodied and emotional aspects of the abortion, as shaped by the three levels of abortion stigma. More broadly, it led to a desire for disembodiment in their abortion experiences as much as possible.

3.1.1. Avoiding enacted and felt stigma via telehealth

The common presence of protestors outside of abortion clinic spaces can lead to enacted stigma, or overt acts of prejudice targeted at abortion seekers, as well as felt stigma, or the fear of being the target of the enacted violence and stigma of protestors and clinic spaces (Herek et al., 2015). For many participants, the fear of encountering protestors was “really stressful,” which manifested in feeling “anxious” and “uncomfortable” about entering clinical spaces. Sophie, a 34-year-old White woman from Massachusetts, shared her feelings about protestors: “I’ve never been to an abortion clinic, but it sounds … I would hate [it] … I don’t really want to deal with someone trying to be outside of a clinic, protesting healthcare decisions I’m making.” This fear of encountering protestors was also present for Charlotte, an 18-year-old White woman in Illinois who used an asynchronous service:

When I went to school, I had to drive past Planned Parenthood a lot and there would be protestors, so that’s another thing that scared me away from going there because I didn’t want to deal with that. I’ve seen really bad videos online about [how] they will get in your face and yell at you and make you feel really bad about it, even if you’re not going in for an abortion. So I just don’t like that.

3.1.2. Avoiding internalized stigma with increased anonymity

The overall negative feelings associated with clinical spaces lead to internalized stigma, whereby many patients wanted to avoid entering and being viewed in these spaces—or as we call it, embodying an abortion patient. For instance, Alex, a 35-year-old Indigenous and Latina woman in California who used a synchronous service, described her stigmatizing feelings about Planned Parenthood: “I couldn’t imagine going to fucking Planned Parenthood, and like sitting there, and having to do this thing with all of the other people who were sitting there possibly having to do this thing as well. Ugh, god, that makes my skin crawl.” For Alex, the thought of being inside a clinic sparked a visceral reaction of disgust and unease in her body. Similarly, Lisa, a 33-year-old White woman from Pennsylvania, described wanting to avoid the clinic space due to the negative energy: “I feel like for me, if I had to go to a clinic, and get examined, and talk to people that just feels like a waste of my time. I don’t want to be in the energy of that situation. It makes it feel real in a weird, bad way, and getting the pills just felt super great.” For Lisa, telehealth allowed her to avoid the physical bodily examination by a provider as well as physically occupying the “energy” of the space. These narratives underscore how perceived abortion stigma manifested in embodied responses like discomfort or disgust to the clinical setting and resulting in a preference for telehealth.

Keisha, a 39-year-old Black woman living in Georgia had two prior medication abortions—one in a clinic and one self-managed with medications acquired from an online source without clinical support—before choosing a synchronous telehealth medication abortion service. She explained why she chose telehealth over an in-person medication abortion, including a desire to avoid being watched:

I didn’t have to go anywhere, and I didn’t have to be watched, making sure I took the pill. Because Planned Parenthood, they watch you take the first pill. It’s like, okay, I’m an adult, I know what I’m here for. Why you got to sit there and watch me? And give me some water for this pill. So, to me that was weird. I feel like they could have just explained to me, if they feel like I didn’t know, here are the pills, take this one and then go ahead. But yeah, I had to take it right in the office … it was really weird to me. I’m just like, why are you watching me take this pill like I’m in jail or something?

Being watched, as Keisha describes, is a key component of embodying an abortion patient, which telehealth circumvents. While the FDA removed the in-person dispensing requirement of abortion medications in 2021, some state laws require abortion medications to be dispensed in-person and taken under the direct observation of the prescribing clinician (U.S. Food and Drug Administration, 2023). In practice, such requirements rendered clinics into perceived sites of surveillance for patients like Keisha, restricting their autonomy and agency during the abortion process, while simultaneously forcing clinicians to act as agents of state surveillance. This is a less discussed component of abortion embodiment, as the broader structures of carcerality, race, and racism influence a patient’s embodied experiences of abortion.

Telehealth medication abortion services also offered perceived anonymity that in-person procedures could not, helping to reduce participants’ internalized stigma. Although their names, photo ID, and other personal information are shared with the telehealth clinic, there is a layer of privacy granted by the virtual option. Keisha appreciated the “discreteness” of the telehealth service, explaining: “So, it’s not like everybody’s in my business or I’m going into a clinic and behind you see eight other women with their boyfriends. So, that’s another thing because you just, again, people are judgmental.” Tia, a 20-year-old multiracial woman from California, shared similar feelings: “I also feel because most of the communication was over the phone, not showing my face … I feel like having that, I guess, anonymity … having that protection of no one really knows who you are or what you look like made me feel much more comfortable with it.” The anonymity of the telehealth process also offered a sense of privacy and comfort for participants. Simone, a 25-year-old Black woman in Illinois who used a synchronous service, explained:

A lot of women don’t want to go to a clinic or a hospital where they’re around dozens or thousands of people. You know I’m exaggerating on the numbers. But I feel like that was important to be in the comfort of my own home. I’m talking to a single doctor who only knows my business, no one else. I don’t need to go through different people. I don’t need to get different ultrasounds, do all of that extra stuff. If I’m already emotionally doing this process and just want to go through it alone.

As these quotes indicate, being seen by not only potential protestors but also providers and other patients, complicated participants’ feelings towards clinic spaces and increased feelings of stigma. Taken together, these participants articulate a desire to avoid embodying an abortion patient, preferring the privacy, anonymity, and disembodiment of a telehealth medication abortion.

3.2. Embodied preference for telehealth medication abortion

In addition to avoiding stigmatized clinic spaces, beliefs and knowledge about abortion shaped a person’s abortion preferences and embodied experiences. Most participants preferred to use telehealth medication abortion services as opposed to in-person medication or procedural abortions. These reasons ranged from reasons found in prior research like convenience, affordability, and privacy (Koenig et al., 2024), as well as more embodied perceptions of pain, invasiveness, and emotion. These preferences were informed by the perceived physical benefits of medication abortion in tandem with the perceived benefits of an entirely remote telehealth abortion.

3.2.1. Medication abortions as “less painful”

The preference for telehealth medication abortion centered around the embodied notion that procedural abortions were more painful than medication abortions, leading some to “always choose the medical over the surgical,” as Keisha, from Georgia, told us. Participants noted that medication abortion, particularly via telehealth, seemed “less painful” and “less traumatizing” than a procedural abortion or in-person medication abortion. Many of these participants based their perceptions of pain on what they had seen or heard about abortion. For example, Gabriela, a 20-year-old Latina in Virginia who used a synchronous service, “heard that [procedural abortion] was harder on the body.” Similarly, Mina, a 24-year-old Asian woman in California who used an asynchronous service, explained her preference:

I don’t know if I should even believe what I read online or what people have told me, but I know some people that have gone the surgical route and they said it was … I think it was D&C or whatever, but they said it was painful. So I just didn’t want to deal with that and also be in an office in a sterile location. So why not do it at home, if I could?

As these quotes indicate, some participants did not distinguish a medication abortion they would have gotten from a brick-and-mortar clinic versus their telehealth experience; Gabriela and others conflate the two types of provision models when describing why they chose a telehealth medication abortion. Despite this conflation, all participants had explicitly chosen telehealth medication abortion over in-person medication abortion for many reasons, including reduced wait times (see Becker et al., 2025). Beyond convenience, these decisions were also shaped by embodied expectations that delaying care would prolong both physical and emotional pain.

Indeed, many participants expressed a preference for telehealth medication abortion out of a desire to end their pregnancies as quickly as possible. In-person medication and procedural abortions often took longer to schedule, with brick-and-mortar clinics having wait times ranging from a few weeks to over a month. When asked if she had considered an in-person abortion prior to choosing telehealth, Tory, a 25-year-old multiracial woman in New York who used an asynchronous telehealth medication abortion service, explained: “Oh, yes, I did but then the wait time was really long. It was about two, three weeks for the appointments to happen and … I wanted the termination to end as quickly and as soon as possible, because it’s worse for the child, worse for me.” For Tory, waiting longer for an in-person abortion implied greater perceptions of pain—the pain of enduring a longer pregnancy, a more difficult abortion process, and a perceived sense of pain for the embryo or fetus.

3.2.2. Medication abortions as less “invasive”

Many participants viewed medication abortion as “more natural,” with many likening their experience to other, more familiar bodily processes like their monthly menstrual cycle. For example, Tory, a 25-year-old multiracial woman in New York, succinctly explained: “I feel like it was normal to my other previous menstrual cycles.” The telehealth model magnified the perception of medication abortion as “more natural,” as it induces the familiar embodied experiences of cramping and bleeding without an in-person clinical encounter, rendering the abortion even closer to the more familiar embodied experiences of a menstrual period or miscarriage (Engle, 2024).

Others made direct comparisons between “natural” medication abortion processes and other more “invasive” abortion methods. Charlotte, an 18-year-old White woman in Illinois who used an asynchronous service, noted that a procedural abortion “seemed very scary.” This fear is partially rooted in misconceptions about abortion procedures due to the term “surgical,” which implies invasive medical tools and a cross-body incision, as well as because it involves a less familiar bodily process. Charlotte explained: “I’ve never had a surgery before, and I couldn’t find a lot of research or topics on what the effects of the surgery would be or how they do it or stuff like that.” Perceptions of and lack of accurate information on procedural abortion processes, exacerbated by abortion stigma, led many participants to choose telehealth medication abortion. Indeed, participants used words like “more invasive” and “less natural” to describe procedural abortions. For example, Emmy, a 24-year-old Asian woman from California who used an asynchronous service, preferred medication abortion because “the procedure is less invasive. They don’t have to go in and do all the other stuff … [and] scoop it out.” Such visceral descriptions illustrate how participants’ preferences for telehealth medication abortion were closely tied to embodied desires to avoid invasive bodily experiences like having their bodies “scooped.” Keisha similarly explained her preference for a more “natural” or familiar abortion process:

I’m terrified of needles and having them go in your cervix, then just the thought of them sucking something out of you. I feel like, I don’t want to say it’s more natural, but to me it’s more natural having medical abortion or it to pass by itself than it getting sucked out of you. So, that’s one of the things that made my decision easier.

Both Emmy and Keisha use similarly embodied language, describing how clinicians “go in” to “scoop” and “suck” out the contents of the uterus, underscoring how preferences for medication abortion are deeply informed by bodily sensations, and a desire to avoid them.

3.2.3. Medication abortions as less “emotional”

Aside from the perceived physical pain of the abortion procedure, participants also presumed procedural abortions would be more “emotional.” This emotionality is believed to be invoked more strongly by the embodied aspects of traditional brick and mortar abortion care—from the physical examinations and/or procedures or from physically being in the clinical setting. Alex, in California, shared her preference for telehealth medication abortion:

This way [telehealth medication abortion] feels, felt, less emotional. I didn’t need to overcomplicate my feelings surrounding it, because it was … Sounds terrible, but it was easy enough to just take a pill and be done with it. You know, that was a decision that I was steadfast in, and I didn’t need to complicate the situation any more.

As Alex’s quote indicates, during a telehealth abortion you can “just take a pill and be done with it” without needing to travel to a clinic for pills or a procedure, therefore reducing the emotions involved. Similarly, Gabriela felt that obtaining an in-person visit would invoke uncomfortable emotions that might sway her decision:

Honestly, I didn’t want to go to an in-office doctor because I don’t know. Personally, I am pro-choice for everybody. But if I were to see an ultrasound or hear a little heartbeat or something like that, I know that just my mother instincts would be like, ‘Oh, my God.’ Yeah. Then I’d probably change my mind. I just didn’t want to get that little … attachment.

Telehealth provided an option for participants to avoid experiencing more intense emotions they associated with other models of abortion care. As Gabriela and others described, encountering the physicality of their pregnancy via hearing a heartbeat or seeing an ultrasound was believed to make the overall abortion experience more uncomfortable, emotional, or complicated. Telehealth was understood as less embodied and therefore easier.

3.3. “That’s kind of the murky waters with it:” Participants’ assessment of completed abortion

While circumventing a clinic via telehealth allowed patients to avoid some embodied aspects of abortion, it led to other heightened embodied experiences at home. For instance, many described uncertainty regarding how to know whether they had successfully completed their abortion. This uncertainty is exacerbated by decreased clinical supervision (including a lack of pre-abortion ultrasound), increased autonomy over the abortion process during telehealth, as well as not having a clinic to go to for an in-person exam if desired. Instead, participants relied on embodied sensations and visuals to signify a complete abortion. Participants described various strategies for assessing the success of the abortion, from noticing a reduction of felt pregnancy symptoms following the abortion to noting significant bleeding or visually seeing the contents of the uterus pass—the corporeal manifestation of the abortion.

3.3.1. Decreased clinical supervision and feelings of uncertainty

Although in a telehealth medication abortion patients consult with a clinician who they could later contact through asynchronous communication, many participants did not reach out to the clinician during their abortion processes. Instead, while managing their abortions in the privacy of their homes, the participants often only relied on telehealth instruction materials and their own sensations to ensure their experiences aligned with the established process. Charlotte, in Illinois, shared how these challenges were heightened they fact that she never met with a clinician in-person:

So I remember being confused about the instructions … because they sent you extra [pills] just in case … They explained it very well, but I wasn’t sure why I had so many extra. I remember taking them was scary for sure because I hadn’t seen a doctor. I have never used a medicine like that through the mail that you don’t have to go somewhere to get it.

Alana, 27-year-old a multiracial law student living in New Jersey who used a synchronous service, similarly shared feelings of embodied uncertainty around her abortion experience:

I felt a little bit like I wasn’t bleeding enough at first. I’m vaguely remembering that maybe I was like, ‘Is this happening the way it’s supposed to?’ … It was kind of a blur once I was in some pain. I kind of stopped obsessively looking at the instructions … I was just like, ‘Yeah, it said you’re going to have cramping and bleeding and I’m definitely having that, so it’s just working as it’s supposed to.’

As Alana’s quote indicates, many rely on their embodied sensations like pain and bleeding to feel confident in the abortion process. In the absence of in-person clinician support, some participants looked to other support people to help understand their physical experiences. For example, Bianca, a 21-year-old Black woman in New York who used an asynchronous service, described how her boyfriend helped look up information to determine if she needed to seek medical support:

There was a point where I was like, ‘Oh, my god. I’m in so much pain. Should I call an ambulance?’ So then I was just like, ‘No.’ My boyfriend was on the phone with me the entire time. He was just like, ‘No, I’m looking this up. You’re going to be fine. Just give it 20 more minutes and the pain’s going to subside.’

However, many participants explained that their support people could not provide as much support or reassurance as a clinician. Kayla, a 27-year-old multiracial woman from New Jersey who used a synchronous service, shared:

I guess in a hospital room somebody’s waiting on you hand and foot and if something’s going on, they could say, ‘Okay, that’s normal.’ I guess the reassurance part of it. I’m not able to be reassured by a professional that, ‘This is normal. This is how it should happen. Your vitals are stable.’ Things like that, or, ‘You’re going to be okay,’ and that kind of thing from my provider, because having my partner is amazing, but he doesn’t really know if this is a natural process I’m about to go through versus what the doctor could have told me.

The decreased presence of and communication with clinicians sometimes resulted in feelings of greater uncertainty when interpreting whether their abortion was complete. Lisa, a 33-year-old White woman from Pennsylvania who used an asynchronous service, expressed a desire to have had more communication with a provider to help her clarify and interpret her abortion experience. She explained:

I think if maybe there was a phone call at some point that would’ve been helpful … Yeah, because for me I don’t want to go to a clinic. I don’t want to deal with the ultrasound, but it is nice to feel like there’s someone there that can walk you through it a little bit. Even though they were available for messaging and stuff like that, I feel like if just someone called me, I could clear things up a little bit.

As Lisa describes, choosing an abortion provision model involves a negotiation of embodied aspects of abortion, often balancing the disembodied avoidance of in person care with increased uncertainty in the absence of a provider. Participants who had an abortion prior to this experience often had more difficulty assessing whether or not their abortion was complete, as they based their expectations on prior abortion experiences. Keisha, from an earlier section, shared how her abortion experiences differed from one another:

It was weird because, usually when I’ve had a medical abortion before, nothing’s easy, but it was painful. So, this last time, when they sent the pills, I was waiting for my cramps to come. I was waiting for the pain to come, and honestly I had zero pain. And I think maybe ‘cause I was so early in my pregnancy, maybe that’s why I didn’t go through what I did the last couple of times I’ve had a medical abortion. So, it was kind of weird for me.

Amy, a 28-year-old Asian woman living in California who used an asynchronous service, shared a similar experience:

My first [abortion], I believe that when they had given me the pill, they had already asked to set up a follow-up appointment … I remember sitting there, and then they said, ‘You’re going to take the first pill right now, actually. And then, tomorrow you’ll take a second pill.’ So it was pretty clear what the timeline was like, ‘And then, you’re going to come back next week just to double check that everything was okay.’ I felt like there was a very clear end point to it all. They kind of set that timeline out for me, and then they guided me through that. This [telehealth] abortion was more like they guided me through the actual process. But then at the very end, I was just like, ‘Oh, I think it worked.’ Everything seemed to work out okay, but it was up to me to get that closure … knowing that this issue is solved, that everything is okay … that’s kind of the murky waters with it.

As Amy aptly put it, without clear guidance or an understanding of the endpoint of an abortion process or a place to go to get confirmation of abortion completion, a telehealth abortion can involve “murky waters” for patients. Participants then turned to embodied sensations, like decreasing pregnancy symptoms and observing their own bleeding and passed tissues, to self-assess abortion completion.

3.3.2. Return to “normal” and the reduction of pregnancy symptoms as a sign of completion

A key indication that the abortion was completed was the diminishing of embodied pregnancy symptoms, or what many participants described as a return to “normal.” For example, Bianca, a 21-year-old Black woman in New York who used an asynchronous service, explained: “literally after everything passed, I was back to normal. I felt completely normal in all senses, and everything went the way [the providers] said it would.” While most participants like Bianca felt “normal” almost immediately, some participants did not recover as quickly. Lisa, from Pennsylvania, shared her experience of using an asynchronous telehealth medication abortion service:

It was way worse than I had anticipated. Then after I got better, is this normal? It didn’t feel normal. It didn’t feel okay. It was horrible … Between having to wait and keep trying to test to make sure [I was no longer pregnant], because I don’t want to do something if I’m not pregnant anymore.

Jessica, a 19-year-old Latina from New York who used an asynchronous service, explained how she knew her abortion was complete by monitoring her pregnancy symptoms: “my symptoms, they just left. Before, the pregnancy symptoms I had were nausea, morning sickness, and my boobs would have blue veins. When I saw that all of that went away, that was a confirmation. But I also took a pregnancy test just to double confirm and it came out negative.” Emmy, a 24-year-old Asian woman in California who used an asynchronous service, similarly shared her experience documenting the gradual diminishment of pregnancy symptoms:

Right after [the abortion], maybe two, three weeks, I was still having the symptoms of being pregnant … Just like breast tenderness. I was craving salty foods. It was just pretty much all the symptoms of being pregnant ….And so I thought that I was still pregnant, and I thought that the pills didn’t work. So that kind of freaked me out. Then I took a pregnancy test, and it turned out positive. So then I’m just like, oh it didn’t work. But you still have all the hormones in your body … so [that was] just my body still kind of releasing all those hormones and everything.

Like others, Isabela, a 16-year-old Latina in California who used an asynchronous service, explained her relief as pregnancy symptoms lessened after her abortion: “I [felt] great … Yeah, because it was just finally over and during that pregnancy, I was really sick, really bad. A lot of morning sickness and a lot of lightheadedness and I couldn’t eat and … it was really bad.” As these quotes illustrate, many participants relied on their bodily cues in the absence of a connection with a physical clinic and provider to determine if their abortion was complete.

3.3.3. “Seeing it visually” and noticeable bleeding as a sign of completion

Another critical factor for knowing whether or not the abortion was complete was seeing significant bleeding and identifying the contents of the uterus—the bodily materiality of the abortion. Gabriela, in Virginia, explained: “The whole week after, just the blood clots coming out, and just all seeing it visually, it was definitely … I 100% knew it was working.” Similarly, Simone, in Illinois, shared: “Once I started to see the blood clots. It wasn’t a lot, it wasn’t like a large chunk, like I was bleeding out and dying or anything, but once I seen that it was a heavy flow, I knew that something had shifted.” For these participants, and others, seeing a lot of bleeding and blood clots confirmed the abortion was complete. Lisa, from Pennsylvania, explained succinctly: “Yeah, I knew I wasn’t pregnant after that. I was like, there’s nothing left here inside this uterus.”

When asked how they knew the medications were working, other participants provided more detailed descriptions of the contents. For example, Tory, from New York, was confident her abortion was completed after seeing the contents: “There was a huge clot, I think that came out and I was like, ‘Oh, that’s probably the child.’ Yeah. So, because, obviously, the big clots aren’t normal when you have your regular menstrual cycle.” Like Tory, Jessica, a 19-year-old Latina in New York who used an asynchronous service, described her experience: “I felt I knew [the abortion was complete] because I saw all the blood, the body parts literally come out, so I was like, ‘I don’t think there’s anything there.’” Such visceral descriptions of the contents of the uterus, from “huge clot” to “the body parts,” illustrate how participants made sense of their expelled pregnancy tissues without the confirmation from a clinician, offering a tangible sense of completion. Taken together, these participants’ stories underline the experiences of telehealth medication abortion as a negotiation between embodiment and disembodiment, including avoiding embodying an abortion patient while having to rely solely on embodied cues like physical sensations and pregnancy tissues with few options for in-person clinical support.

4. Discussion

The findings of this study extend a robust body of literature that has explored experiences of medication abortion. Such research has demonstrated preference for telehealth medication abortion as a way to overcome logistical and financial barriers associated with in-person abortions, and based on an increased sense of privacy and autonomy as well as a desire to avoid procedural abortion (Aiken, Starling, & Gomperts, 2021; Becker, 2023). While these studies have extensively explored motivations and preferences for medication abortion, only a small number of studies have examined the embodied experiences of medication abortion (see e.g., Arey et al., 2023; Broussard, 2020; Purcell et al., 2017) which center the feelings of bodily sensations and materialities as part of abortion care. This study builds on this growing body of literature by focusing specifically on the embodied experiences of people who accessed telehealth medication abortion. As a relatively new form of abortion provision in the United States, the lack of familiarity of telehealth medication abortion likely shapes embodied experiences. In particular, experiencing every aspect of an abortion from home does not fit into the cultural imaginary of an abortion, which typically includes negative aspects like driving long distances to a (culturally stigmatized) clinic or encountering protestors (Herold & Sisson, 2019). Stigmatized cultural images also assume abortion is inherently “dangerous,” “dirty,” and “risky” (Ward, 2021), which may further influence the embodied experience of telehealth medication abortion.

Abortion stigma and gaps in abortion knowledge particularly influenced participant preferences for telehealth medication abortion over in-person medication or procedural abortions. This is partially due to medication abortion having more similarities with other familiar bodily experiences. While not everyone has visited an abortion clinic for a medication or procedural abortion—let alone an in-person procedure that might require anesthesia, a recovery time, and a support person picking you up from the clinic—most people with pregnancy capacity have swallowed pills and had menstrual periods at home or at work. Coupled with having the entire abortion process from home, the relative embodied familiarity of medication abortion shaped this participant preference. However, stigma also plays a part in this preference, as some are unfamiliar with procedural abortion methodologies—which is often inaccurately referred to as “surgical abortion,” which might increase fear (Nguyen et al., 2023; Upadhyay et al., 2023). Some participants mentioned visiting an in-person clinic for a medication or procedural abortion would be “more emotional,” “more traumatizing,” and/or more painful, and many were afraid of the widespread ultrasound requirements, which telehealth abortion averts. While many patients prefer telehealth abortion and are satisfied by the provision model (Koenig et al., 2024), it is also possible that with adequate abortion education, lessened stigma, and reduced structural barriers to abortion, some might actually prefer an in-person procedure over medication abortion more broadly. Nonetheless, in the face of enduring and pervasive abortion stigma and barriers to care, having options in the delivery of abortion care is key for patient autonomy and access. Indeed, emerging research has found that telehealth medication abortion mitigates structural barriers to care, as well as reduces patients’ feelings of internal, interpersonal, and structural stigma (Becker et al., 2025). Our study builds on this research by highlighting how virtual telehealth medication abortion clinics allow patients to avoid in-person abortion clinic spaces they perceive to be stigmatizing.

Specifically, our findings allude to a desire to avoid what we call embodying an abortion patient, which refers to the experience of physically occupying the role of “abortion patient” in a clinic. Extant research has explored the embodied experiences of in-person abortions, demonstrating how patients navigate complex legal, social, and emotional environments surrounding abortion clinics (Amuchástegui, 2013; Ludlow, 2008). Here, we extend this conceptualization to account for a desire to avoid not only the logistical hassles involved with arriving to a clinic, but also the psychological and social burdens of physically being in an abortion clinic space and being perceived as an abortion seeker by not only potential protestors but also by other patients and providers. Indeed, participants in our study shared a preference for telehealth medication abortion over other abortion methods in order to avoid physically being in a clinical space, which was believed to lead to discomfort or worse. Some participants of color also wanted to avoid feelings of surveillance or carcerality associated with having a clinician watch you take a pill and dictate the timing of your abortion.

As a contrast to the perceived and felt stigma in abortion clinic spaces, telehealth empowers patients to choose when to take the pills based on preferences and schedules. For many, physical separation from the clinician vis-à-vis a phone or computer screen granted an emotional buffer from the abortion process—allowing one to avoid being “in the energy of the situation,” as one interviewee put it. In addition, many participants also appreciated being able to ask for an abortion and ask questions regarding the abortion using a messaging platform rather than face-to-face video, which allowed for an increased sense of privacy and anonymity. While some abortion seekers might feel comfortable with, or even prefer, embodying an abortion patient in a clinic (Amuchástegui, 2013), the participants in this study sought telehealth abortion care in order to avoid this process.

For others, lack of clinical supervision and follow-up led to uncertainty around their abortion, leading to an increased reliance on bodily sensations and visual cues. This included what embodied experiences were “normal” or which required in-person follow-up or emergency care. In some cases, people were confused about whether their abortion was successful or completed. This uncertainty is exacerbated due to patient gaps in abortion knowledge as well as a mismatch between expectation and embodied experience, including experiencing more or less pain and bleeding than they expected (McCulloch et al., 2025). Patients’ ability to confirm that their medications worked is critical for telehealth patients, particularly for those completing their abortions in a state with abortion bans, where getting additional care can be legally dangerous or structurally limited. These findings build on a body of literature that has explored how care seekers are able to self-assess for abortion completion without clinical supervision (Cameron et al., 2015; Grossman & Grindlay, 2011; Raymond et al., 2018; Pleasants et al., 2024). While prior research has identified effective self-assessment strategies (Grossman & Grindlay, 2011), including the use of at-home pregnancy tests (Cameron et al., 2015; Raymond et al., 2018), our study highlights the unique challenges telehealth medication abortion seekers face when managing their abortions entirely at home and self-assessing completion. Moreover, we view it as a negotiation of embodied elements of abortion—balancing the benefits of avoiding the clinical space with the increased uncertainty of decreased clinical supervision. With lessened clinical oversight, participants relied on embodied sensations, such as the gradual reduction of pregnancy symptoms, and varied interpretations of the expelled contents of the uterus, which aligns with other research about the visuals of aborted tissues as making the abortion “more real” (Becker & Hann, 2021). Together, these findings extend understandings of abortion embodiment, highlighting how telehealth shapes the bodily preferences and responses to stigma, surveillance, and uncertainty in abortion care. In doing so, telehealth reconfigures the embodied experience of abortion, offering patients greater autonomy while reshaping how they physically and emotionally engage with the process.

4.1. Limitations

This study must be understood in the context of its limitations. First, this study draws on 30 in-depth interviews, and is therefore not intended to be representative of all experiences with telehealth medication abortion. Rather, this study provides an in-depth analysis of embodied abortion experiences by carefully attending to the narratives shared by study participants. Additionally, the interviews were not explicitly focused on the embodied experience of telehealth medication abortion. Future research should directly attend to embodied experiences, including through the use of other qualitative methods such as body mapping (Jager et al., 2016), to elucidate deeper analysis of bodily experiences with abortion care. Future research would also benefit from exploring embodied experiences of other remote or self-managed forms of abortion care. Importantly, participants in the sample broadly represented patients accessing care from abortion-supportive states. Individuals seeking telehealth medication abortion from states with abortion restrictions or bans may have distinct embodied experiences. Furthermore, this study took place prior to the Dobbs v. Jackson Women’s Health Organization decision that overturned constitutional protections for abortion care. Future research might explore how individuals’ decisions to seek telehealth medication abortion, as well as their embodied experiences of medication abortion, differ in legally restrictive settings post-Dobbs. Future studies might also address how these embodied experiences and preferences differ between people who chose telehealth versus people who chose in-person care. Lastly, many of our findings here could apply to medication abortion more broadly; however, we sought to explain the role of telehealth in shaping these experiences.

5. Conclusion

This paper draws attention to embodied—and disembodied—experiences of telehealth medication abortion. Our findings suggest how participants’ assessment of a “successful” or completed abortion, as well as their preference for telehealth medication abortion care, are deeply shaped by broader social forces, particularly abortion stigma. In doing so, we call attention to the power of broader social structures in shaping lived experiences of healthcare. Understanding the embodied experiences of medical interventions is important for improving delivery of care.