Addressing Language Access for
Reproductive Telehealth Care
Individuals with limited English proficiency (LEP) encounter systemic inequities when trying
to access health care, including unique challenges to benefiting from telehealth services.1
About one in five people in the United States
speak a language other than English athome2—including nearly 26 million or 9% of
the U.S. population with LEP3—and more than
350 languages other than English are spoken
across the U.S.4
Í32% of Asian Americans and 12% of Native
Hawaiians and Pacific Islanders (AANHPIs)
in the U.S. have LEP,5 and language barriers
may prevent them from going to check-ups
and addressing unmet health care needs.6ÍMore than 1 million Latinas7 who live instates that have banned abortions, or arelikely to, report not speaking English at
all or not speaking it well, making it morechallenging for them to access culturallycompetent abortion care.8

ÍOverall, adults with LEP are more likely to
be uninsured—Spanish-speaking persons
being the most likely—and lack a usual
health care provider than individuals whoare English proficient.9, 10

Importantly, immigrants are significantly morelikely than U.S.-born individuals to have LEP:
56% of noncitizens and 37% of naturalized
citizens have LEP compared to 2% of U.S.-born
citizens.11 For immigrants with LEP, it can bedifficult to access health care services due todifficulty speaking or understanding English.12

Even though research shows that qualified
interpreters can help improve LEP individuals’
service quality and health outcomes as well as
reduce medical errors, language services may
not always be available.13, 14
ÍOne study found that fewer than a thirdof outpatient physicians had regularly
used a professional interpreter whencommunicating with patients with LEP,
and 40% had never used professional
interpreters.15

ÍAbout one-fourth of U.S. hospitals thatserve populations with high or moderateneed for language services—and morethan one-third of hospitals that serve
populations with low need—do not offer
language services.16

Studies have shown that patients with LEP
are less likely to use telehealth compared with
their counterparts who speak English fluently,17
and are less likely to use telehealth video visits
when accessing virtual services compared toadults comfortable speaking English.18

Accessing reproductive health care—and notably, abortion services—can be especiallydifficult for LEP individuals due to financial, travel, or language barriers.19
Insurance coverage barriers: People with LEP may not receive information on how toapply for and enroll in health insurance plans and programs in their own language.20
Additionally, many newly admitted immigrants are barred for five years from enrolling infederal health insurance programs, and immigrant women are less likely to have healthinsurance coverage and use sexual and reproductive health services than U.S.-born
women. 21, 22, 23
Travel barriers: Immigrants living without documentation—a majority of whom are notproficient in English—may have no way of obtaining abortion care or gender-affirming
care: immigration law enforcement prevents them from traveling out of state to aprovider, and customs border patrol checkpoints may prevent border residents fromtraveling for care.24, 25, 26
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Lack of culturally appropriate information: Without having access to accurate informationin their own language, LEP individuals may be vulnerable to false claims about the legalityof reproductive health services and the implications of receiving such services, especiallyabortion and gender-affirming care.
ÍLEP populations may also be more vulnerable to anti-abortion centers that provide
medically inaccurate information in order to steer people away from deciding to havean abortion.27, 28

ÍAsian Americans and Native Hawaiians and Pacific Islanders (AANHPIs) may facelanguage barriers in their efforts to access reproductive health care.29 One study that
focused on AANHPIs found that 35% of participants had not heard of medicationabortion (or weren’t sure that they had heard of it), and nearly half of the participants
did not know where or how to access it.30

Telehealth presents an opportunity to ensure everyone can make informed decisions about
their bodies, lives, and futures without barriers because of language proficiency. However,
obstacles remain that need to be overcome.

A range of sexual and reproductive health services—including contraception, medication abortion,
STI care, prenatal and postpartum care, perimenopause and menopause care, and gender-affirming
care—can be provided via telehealth, and telehealth can improve patient access to these services.31
ÍOne study found that patients preferred telehealth for sexual and reproductive health care in aprimary care setting, and especially for contraceptive counseling.32

ÍTransgender and gender-diverse people have reported highly positive perceptions of telehealthdelivered gender-affirming care, and improved access to gender-affirming care via telehealth.33,
34

Í

Notably, telehealth models for medication abortion care are equally as safe as in-person models
and could enable patients to access abortion care earlier in their pregnancy.35

ÍData from the TelAbortion study in the U.S. confirms previous findings that providing
medication abortion through telehealth and mailed medication is safe and effective. Amongnearly 1,400 abortions provided this way, 95% were completed without a subsequent procedural
abortion, and 99% experienced no serious adverse events.36

Although telehealth for medication abortion care has proven to be safe and effective, medicallyunnecessary state regulations restrict patient access to it, intensifying barriers to access for LEP
individuals.
ÍAs of May 2024, 15 states have enacted abortion bans, and 6 states have enacted various
gestational limit bans at 6, 12, 15, or 18 weeks.37

24 states either ban telehealth for medication abortion care or require in-person visits, which
effectively ban the use of telehealth services.38
Bans on insurance coverage for abortion, including under Medicaid39, limit access and disproportionately impact those who already face significant barriers to receiving quality care, such as people living with low-incomes, immigrants, and people of color.40

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ÍIn Colorado, for example, one-third of Latine individuals and more than half (55%) of Latine
children are covered by Medicaid. Both Latine people overall and children are more likely to becovered by Medicaid than the state population overall (19% for all Coloradans and 35% for allchildren).41 At the same time, Latine teenagers have the highest birth rate in Colorado comparedto other races.42

ÍA 2019 study in Louisiana found that about 29% of Medicaid-eligible pregnant women who
would have an abortion if Medicaid covered abortion instead give birth.43 This finding is
consistent with a landmark 2009 study that found that severe restrictions on Medicaid coverageof abortion force 1-in-4 low-income women who seek abortion to carry an unwanted pregnancy
to term.44

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Concrete programmatic and policy changes can help ensure that LEP individuals haveaccess to reproductive telehealth care and abortion care via telehealth.
Several federal statutes—including Title VI of the Civil Rights Act of 1965 and Section
1557 of the Affordable Care Act—require that federal entities or health care organizations
receiving federal funds, such as through Medicare or Medicaid/CHIP, must meet thelanguage needs of LEP clients.45, 46
Í While this requirement is not always fulfilled in practice, there is an opportunity forstates to take initiative around telehealth. States have the flexibility to cover Medicaidservices provided via telehealth and that meet the language needs of patients.47
Telehealth platforms and health care providers can increase accessibility for LEP individuals
by providing multilingual support for delivery of services such as:48
Í Interpreter services for both video and phone platforms;
Í Translation for appointment scheduling emails and intake or follow-up forms;
Í Translation services for messaging between patients and providers that can be built
into electronic health record systems.49

There is potential to enhance and protect reproductive health care access for LEP
individuals by advancing policies that centers language access, insurance coverage, andanti-discrimination.

Telehealth has the potential to enhance sexual and reproductive health care forindividuals with LEP if policies and programs center equity in their design andimplementation. Reproductive equity without access is not freedom.

GLOSSARYÍTelehealth: Telehealth enables health care providers to treat patients virtually without an in-person
appointment. Patients can connect directly with a health care provider from any location and thiscan be done in a variety of ways, including via live video (“synchronous”), the phone, secured chat(“asynchronous”), and other telecommunications.

ÍIndividual with limited English proficiency: Individuals who do not speak English as their primarylanguage and who have a limited ability to read, speak, write, or understand English.

ÍSexual and reproductive health: A state of physical, emotional, mental and social well-being in relation toall aspects of sexuality and reproduction. Services include but are not limited to contraception, abortion
care, sexually transmitted infection screening and treatment, and fertility services.

ÍMedication abortion: A safe and effective FDA-approved medication regimen for ending an earlypregnancy. It is an abortion option that is approved for use up to 10 weeks in pregnancy. The regimen
involves two different pills. One pill, called mifepristone, is taken first and then pills, called misoprostol,are taken 24-48 hours later. It is also safe and effective to use misoprostol only as a regimen formedication abortion. As restrictions around mifepristone complicate its availability, it’s important to notethat misoprostol is safe, effective, widely available, and easy to administer.

ÍProcedural abortion: An abortion method that uses suction to take a pregnancy out of the uterus.
Suction abortion (also called vacuum aspiration) uses suction to empty the uterus, and is used until
about 14-16 weeks after an individual’s last menstrual cycle. Dilation and Evacuation (D&E) is anotherkind of in-clinic abortion procedure. It uses suction and medical tools to empty the uterus, and can be
performed later in a pregnancy than aspiration abortion.

ÍAnti-abortion centers: Organizations that present themselves as health care clinics while providing
counseling explicitly intended to discourage and limit access to abortion and pressure individuals intoadoption or parenting.

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1. mHealth Intelligence. Understanding Telehealth Barriers for Limited English Proficiency Patients. December 2022.
2. U.S. Census Bureau. What Languages Do We Speak in the United States? December 2022.
3. KFF. Overview of Health Coverage and Care for Individuals with Limited English Proficiency (LEP). July 2023.
4. U.S. Census Bureau. Census Bureau Reports at Least 350 Languages Spoken in U.S. Homes. November 2015.
5. Urban Institute. Many Asian American and Native Hawaiian/Pacific Islander Adults May Face Health Care Access Challenges Related to Limited English Proficiency. December
2022.
6. Jang, Y. & Kim, M. Limited English Proficiency and Health Service Use in Asian Americans. Journal of Immigrant and Minority Health. April 2019.
7. While this resource aims to use gender neutral terms, it specifies gender when necessary to accurately represent research and data findings.
8. National Partnership for Women & Families. State Abortion Bans Threaten 6.5 Million Latinas. November 2022.
9. Foiles Sifuentes, A., Robledo Cornejo, M., Chen Li, N., Castaneda-Avila, M., Tjia, J. & Lapane, K. The Role of Limited English Proficiency and Access to Health Insurance and HealthCare in the Affordable Care Act Era. Health Equity. December 2020.
10. KFF. Overview of Health Coverage and Care for Individuals with Limited English Proficiency (LEP). July 2023.
11. Ibid
12. KFF. Five Key Facts About Immigrants with Limited English Proficiency. March 2024.
13. Karliner, L., Jacobs, E., Chen, A., & Mutha, S. Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature.
Health Services Research. April 2007.
14. Parker, M., Fernandez, A., Moffet, H., Grant, R., Torreblanca, A., & Karter, A. Association of Patient-Physician Language Concordance and Glycemic Control for Limited-English
Proficiency Latinos With Type 2 Diabetes. JAMA Internal Medicine. March 2017.
15. Schulson, L., & Anderson, T. National Estimates of Professional Interpreter Use in the Ambulatory Setting. Journal of General Internal Medicine. November 2020.
16. Schiaffino, M., Nara, A., & Mao, L. Language Services In Hospitals Vary By Ownership And Location. Health Affairs. August 2016.
17. Rodriguez, J., Saadi, A., Schwamm, L., Bates, B., & Samal, L. Disparities In Telehealth Use Among California Patients With Limited English Proficiency. Health Affairs. March 2021.
18. Hsueh, L., Huang, J., & Millman, A. Disparities in Use of Video Telemedicine Among Patients With Limited English Proficiency During the COVID-19 Pandemic. Jama Network Open.
November 2021.
19. Ibis Reproductive Health. Barriers to sexual and reproductive health services faced by immigrant women of reproductive age in the United States. January 2023.
20. State Health Access Data Assistance Center. State Estimates of Limited English Proficiency (LEP) by Health Insurance Status. May 2014.
21. All Above All. Abortion Justice for Immigrants.
22. Hasstedt, K., Desai, S. & Ansari-Thomas, Z. Immigrant Women’s Access to Sexual and Reproductive Health Coverage and Care in the United States. The Commonwealth Fund.
November 2018.
23. Guttmacher Institute. New Analyses on US Immigrant Health Care Access Underscore the Need to Eliminate Discriminatory Policies. May 2022.
24. Guttmacher Institute. Inequity in US Abortion Rights and Access: The End of Roe Is Deepening Existing Divides. January 2023.
25. Pew Research Center. U.S. unauthorized immigrants are more proficient in English, more educated than a decade ago. May 2019.
26. Physicians for Human Rights. Zero Protection: How U.S. Border Enforcement Harms Migrant Safety and Health. January 2019.
27. ABC News. Challenges increase for immigrants accessing abortion after Roe reversal. July 2022.
28. NARAL Pro-Choice. Translating Abortion Disinformation. May 2022.
29. AAPI Data. STATE OF ASIAN AMERICANS, NATIVE HAWAIIANS, AND PACIFIC ISLANDERS IN THE UNITED STATES. June 2022.
30. Choimorrow, S.Y., Lindsey, A., Key, K. Ow, A. & Gerdts, C. Medication abortion among Asian American, Native Hawaiians, and Pacific Islanders: Knowledge, access, and Attitudes.
National Asian Pacific American Women’s Forum. May 2023.
31. KFF. Telemedicine in Sexual and Reproductive Health. November 2019.
32. Srinivasulu, S., Maze, M., & Jones, H. “I totally didn’t need to be there in person”: New York women’s preferences for telehealth consultations for sexual and reproductive healthcare in primary care. Family Practice. April 2023.
33. Apple, D., Lette, E., Wood, S., Freeman Baber, K., Chuo, J., Schwartz, L., Petsis, D., Faust, H., & Dowshen, N. Acceptability of Telehealth for Gender-Affirming Care in Transgenderand Gender Diverse Youth and Their Caregivers. Transgender Health. April 2022.
34. D’Angelo, A., Argenio, K., Westmoreland, D., Appenroth, M., & Grov, C. Health and Access to Gender-Affirming Care During COVID-19: Experiences of transmasculine individuals
and men assigned female sex at birth. American Journal of Men’s Health. November-December 2021.
35. Grossman, D. & Grindlay, K. Safety of medical abortion provided through telemedicine compared with in person. Obstetrics & Gynecology. October 2017.
36. Chong, E., Shochet, T., Raymond, E., Platais, I., Anger, H.A., Raidoo, S., Soon, R., Grant, M.S., Haskell, S., Tocce, K., Baldwin M.K., Boraas, C.M., Bednarek, P.H., Banks, J., Coplon, L.,Thompson, F., Priegue, E., & Winikoff, B. Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic. Contraception. March 2021.
37. Guttmacher Institute. Interactive Map: US Abortion Policies and Access After Roe. March 2024.
38. RHITES. State Laws Impacting Telehealth for Medication Abortion Care (TMAB). March 2024.
39. The Hyde Amendment has banned the use of any federal funds for abortion since 1977, only allowing exceptions to pay for terminating pregnancies that endanger the life of thepregnant individual, or that result from rape or incest.
40. Jones, R. Medicaid’s role in alleviating some of the financial burden of abortion: Findings from the 2021–2022 Abortion Patient Survey. Perspectives on Sexual and Reproductive
Health. February 2024.
41. UCLA Latino Policy & Politics Institute. 15 Facts about Latino Well-Being in Colorado. February 2023.
42. Martin J., Hamilton B., Osterman M., Driscoll, A., & Matthews, T. Births: Final data for 2015. National Vital Statistics Report. January 2017.
43. Roberts, S., Johns, N., Williams, V., Wingo, E., & Upadhyay, U. Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion. BMC Women’s Health. June 2019.
44. Henshaw, S., Joyce, T., Dennis, A., Finer, L., & Blanchard, K. Restrictions on Medicaid funding for abortions: a literature review. Guttmacher Institute. July 2009.
45. Balderas-Medina Anaya, Y., Hernandez, G., Hernandex, S., & Hayes-Bautista, D. Meeting them where they are on the web: addressing structural barriers for Latinos in telehealthcare. Journal of the American Medical Informatics Association. October 2021.
46. PatientEngagementHIT. Understanding Patient Rights to Medical Interpreters, Language Access. August 2022.
47. NHeLP. Medicaid and CHIP Reimbursement Models for Language Services. March 2024.
48. Kim, J-H., Desai, E., & Cole M. How The Rapid Shift To Telehealth Leaves Many Community Health Centers Behind During The COVID-19 Pandemic. Health Affairs. June 2020.
49. Balderas-Medina Anaya, Y., Hernandez, G., Hernandex, S., & Hayes-Bautista, D. Meeting them where they are on the web: addressing structural barriers for Latinos in telehealthcare. Journal of the American Medical Informatics Association. October 2021.

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