Telemedicine and mail-in pill abortions are safe and effective, research shows
The research
The study, led by researchers at the University of California, San Francisco, looked at the experiences of more than 6,000 patients in the months after the federal government began allowing the mailing of abortion pills, from April 2021 to January 2022.
The patients used one of three telemedicine abortion organizations – Hey Jane, Abortion on Demand or Choix – serving 20 states and Washington DC. The study, published Thursday in Nature Medicine, ended five months before the Supreme Court overturned Roe v. Wade. causing a wave of state abortion bans and restrictions. Since then, more telemedicine services have opened, used by many patients who find the method more convenient, private and affordable than visiting clinics or doctors, especially if they have to travel to another state.
The services in the study prescribed pills to patients who were ten weeks pregnant or less (one service had an eight-week limit) and screened patients for medical problems that make them ineligiblesuch as ectopic pregnancies or blood clotting disorders.
In most cases, the services' doctors, nurses, physician assistants and midwives were able to determine eligibility based on patients' written or verbal information about their pregnancy and health, without having to perform ultrasound scans, which is logistically difficult to obtain for some patients. . If medical eligibility was unclear, patients were asked to undergo ultrasound scans; 486 did so and were subsequently prescribed pills, which was about 8 percent of the 6,034 patients who received pills in the study.
The results
Researchers reviewed the services' medical records and were able to determine abortion outcomes in three-quarters (4,454) of patients. A large majority – 4,351 patients, or 97.7 percent – completed abortions with the standard regimen: mifepristone, which stops the development of a pregnancy, followed a day or two later by misoprostol, which causes contractions to expel the tissue.
Of the remaining patients, 85 required additional measures to complete the abortion, usually with additional medication or a suction procedure in a medical facility.
Eighty-one patients visited the emergency department and 15 patients had serious complications. Ten patients were hospitalized. Six received a blood transfusion, two were treated for infections and one had surgery for an ectopic pregnancy.
Six patients turned out to have had an ectopic pregnancy, which would make them ineligible for the pills. Studies show that ectopic pregnancies cannot always be identified early, even with the help of ultrasound.
Of the patients who visited the emergency room, 38 percent ultimately did not require treatment. Patients sometimes visit the emergency room because “they don't know if what they're experiencing is normal and sometimes they don't have anyone to ask and they don't want to tell many people about their abortion,” says Dr. Ushma Upadhyay, a public health scientist at UCSF and a of the study authors.
No patients were found who were more than 10 weeks pregnant.
The effectiveness and safety figures were comparable to those in several major studies by personal medication abortion and from telemedicine abortion requiring ultrasound. They were also comparable to the Food and Drug Administration rates label for mifepristone.
Researchers also found no difference in safety or efficacy in patients who received real-time video consultations, compared to those who received prescriptions based on written information provided via text message, which most patients did.
Two patients asked about “abortion pill reversal,” a non-scientific theory that abortions can be stopped after taking the first drug. Both were told that “evidence-based recovery treatment does not exist” and were referred to urgent personal care, the study reported.
Bigger implications
Medication abortion is being challenged in a lawsuit filed against the FDA by abortion opponents who want to restrict mifepristone. One of the plaintiffs' claims is that abortion pills are dangerous. The FDA has cited overwhelming scientific evidence that the pills are safe, and two studies that abortion opponents cited to support their claims were recently retracted by a scientific journal publisher.
In August, an appeals court said mifepristone could remain legal, but imposed significant restrictions that would prevent it from being sent or prescribed via telemedicine. The Supreme Court will hear arguments in the case next month. The new study results could be cited by those urging the court to keep abortion available via telemedicine.