“We now have robust evidence that providing early medication abortion using a model that has no clinical tests and is done by telemedicine is just as safe and effective as a fully in-person model.”
For years, anti-abortion advocates have claimed the abortion pill is dangerous. In 2000, when the U.S. Food and Drug Administration approved the abortion pill for sale in the U.S., they bowed to anti-abortion pressure by placing the abortion pill under a drug safety program that requires doctors to distribute the pills in person to their patients.
That restriction, still in place today, bars the use of telemedicine abortion in the U.S., even during the pandemic—despite strong evidence that telemedicine abortion is safe and effective. This evidence just became much stronger. A new study out of the U.K. provides the first real-world evidence in a national population that no-test telemedicine abortion is just as safe and effective as in-person abortion health care.
Before the pandemic, the standard medical protocol for medication abortion in the U.K. required patients to make an in-person visit to their health care provider for an ultrasound scan and to receive the abortion pill. When COVID-19 hit, the Royal College of Obstetricians and Gynaecologists published new guidelines for medication abortion: Consultations were encouraged to take place by telephone or video call and an in-person visit and ultrasound scan were required only if indicated.
By the end of March 2020, the British government had issued emergency legal orders allowing no-test medication abortion where abortion providers could treat their patients via telemedicine and mail abortion pills to their patients to take at home.
This shift in policy allowed researchers for the first time to assess a real-world no-test telemedicine abortion care model in a national population. Researchers compared patients receiving the traditional in-patient model of care, with in-clinic ultrasounds, to a telemedicine-hybrid model where patients are screened for eligibility for telemedicine abortion care without an ultrasound. Based on a sample size of 52,142 people, researchers found that no-test telemedicine abortion model is just as safe and effective as the traditional in-person medication abortion model. Patients actually preferred this option to the in-person model.
“We have now robust evidence that providing early medication abortion using a model that has no clinical tests and is done by telemedicine is just as safe and effective as a fully in-person model,” said the study’s lead author, Abigail Aiken, Assistant Professor in LBJ School of Public Affairs at the University of Texas at Austin. “That is particularly significant because we have so many state laws here in the US that are set up to prevent exactly that type of a model from being put into place. This study is showing us that there is really no reason in terms of safety, or effectiveness, or indeed patient acceptability not to go ahead with that kind of model.”
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In the United States, in addition to the FDA restriction, nineteen states require the clinician providing a medication abortion to be physically present when the medication is administered, thereby prohibiting the use of telemedicine to prescribe the abortion pill remotely.