Research has long found that medication abortion is safe and effective, but a new study shows that to be true even when the patient gets the medicine through a telehealth appointment.
Medication abortion, also known as medical abortion, is the method by which someone ends their pregnancy using pills rather than a surgical procedure. It’s the most common form of abortion in the United States.
It’s also come under fire recently. In April, a Texas judge suspended the US Food and Drug Administration’s approval of mifepristone, one of the drugs used in the practice in the United States. The medication is still available while the ruling is under review by the US Supreme Court.
US providers have offered telehealth services for medication abortion at some level since around 2008, but it became a much more widely used option during the Covid-19 pandemic. In 2021, the FDA said it would no longer require an in-person appointment for a provider to dispense the drugs, making way for more virtual appointments in states where abortion and telehealth for abortion aren’t banned.
The latest study, published Thursday in the journal Nature Medicine, shows that with very rare exceptions, telehealth for medication abortion is effective and safe, whether the person uses a secure form of texting or a video call. Most of the participants in the study worked with a provider through text, although they could also have a followup call or videoconference.
The study looked at records from 6,034 medication abortions provided via telehealth between April 2021 and January 2022 at three virtual clinics that operate in 20 states and the District of Columbia. The effectiveness and safety of medication abortion provided through video and text appointments was found to be similar to numbers in other studies involving in-person medication abortion care.
As with in-person appointments, the patients who chose the telehealth option weren’t required to undergo any testing or physical examination; rather, a provider made the decision to provide abortion medication based on their medical history.
Medication abortion is intended to be used up until 10 weeks after the start of the pregnant person’s last menstrual period. It is not recommended for people with certain health conditions and those who have had an ectopic pregnancy, a rare event in which a fertilized egg implants itself outside of the uterus.
In the new study, patients who had any risk factors or symptoms for an ectopic pregnancy or those who were potentially beyond the required gestational age were referred for an ultrasound.
Of the 6,034 abortions in the study, 99.8% were not followed by a serious adverse event.
”In total, 0.25% of patients experienced a serious abortion-related adverse event, 0.16% were treated for an ectopic pregnancy and 1.3% abortions were followed by emergency department visits,” the study says.
The study also showed that medication abortion was highly effective, as 97.7% of participants had a complete abortion after taking the pills, with no need for any subsequent intervention. Among those whose abortion was not initially complete, 0.56% took more medication to complete the procedure, 1.4% needed a surgical procedure, and 0.94% had a confirmed or suspected continued pregnancy.
The results were similar for patients no matter their race, ethnicity or age.
“Telehealth medication abortion is effective, safe, and comparable to published rates of in-person medication abortion care,” concluded the researchers, from the University of California, San Francisco.
The new study is helpful to reinforce that the practice is safe and effective, said Dr. Pratima Gupta, an abortion provider in San Diego who was not involved in the new research.
“It’s great to have research data to support what we already knew regarding the safety of medication abortion,” she said.
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Medication abortion is one of the most common procedures performed in the United States, Gupta said. Telehealth options meet patients’ needs, she said, and that may be more important than ever with more states restricting access to abortion since the US Supreme Court overturned Roe v. Wade in 2022.
“I think it’s really wonderful that we’re able to meet patients where they’re at. So whatever their preferred method of communication is, whether it’s texting, whether it’s telephone, whether it’s video, so we are able to meet their needs with accessibility,” Gupta said. “And it provides them the necessary privacy to control their lives.”