February 15, 2024
3 minute read
Study finds medication abortion using telemedicine is as safe as in-person care
Researchers have found that medication abortion performed at home via Zoom or text link to a doctor is extremely safe and effective.
A new study shows that the combination of mifepristone and misoprostol, a two-drug regimen commonly prescribed to terminate a pregnancy, is extremely safe and effective—even when the medication abortion is performed through a remote telemedicine connection. In a study of more than 6,000 remote medication abortions between April 2021 and January 2022, only 0.25 percent of patients experienced adverse effects, such as excessive bleeding or infection. Less than 2.5 percent had an ongoing pregnancy. Published February 15 in Natural medicine, This study is the largest study of home-based telemedicine abortion to date.
“The study found that providing telehealth care was as safe and effective as providing abortion care in person,” said Ushma Upadhyay, a quantitative public health researcher at the University of California, San Francisco, and lead author of the paper. In addition to synchronous abortion, in which the patient communicated with a provider over the phone or video chat, Upadhyay's team evaluated asynchronous care, in which the patient and provider did not interact in real time. The researchers found that both approaches produced equally successful results.
“Providing the option for asynchronous care really helps improve access,” says Kelly Cleland, executive director of the American Society for Emergency Contraception, who was not involved in the study. For example, receiving abortion care through secure text messages may be a better option for people who live in rural areas with limited access to Wi-Fi or may face threats of intimate partner violence. New research confirms this is a safe and effective option, Cleland says.
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Medical abortion accounts for more than half of all abortions in the United States, according to research. 2022 survey from the Guttmacher Institute. It is a vital form of health care for people who live in an area where there is no easy access to an abortion clinic or where abortion is illegal. Most experts predict that the rate of medication abortions in the U.S. will only increase in the coming years as waves of COVID continue to rise and care options become increasingly limited in many parts of the country.
Most medication abortions first use 200 milligrams of mifepristone, which blocks the release of the hormone progesterone, followed by up to 1,600 micrograms of misoprostol, which causes the uterus to have a bowel movement. Despite more than 20 years of data demonstrating their safety, both drugs, and especially mifepristone, have been subject to repeated scrutiny and regulatory challenges. This trend has not slowed since the Supreme Court's 2022 decision on Dobbs v. Jackson Women's Health Organization which canceled Roe v. Wade.
“This is really important and timely evidence,” says Silpa Srinivasulu, a public health researcher at the Reproductive Health Access Network who was not involved in the study. The new study comes just weeks before the Supreme Court is set to hear a case that could jeopardize the Food and Drug Administration's approval of mifepristone and effectively ban its use.
Current guidelines require mifepristone to be prescribed by a board-certified physician to patients of 10 weeks or less. In 2021, the agency expanded approval of the drug to include telemedicine prescriptions, a provision that helped thousands of Americans stay safe during the height of the COVID pandemic. Shortly thereafter, however, abortion advocates filed a lawsuit challenging not only the updated guidelines but also the FDA's original approval of mifepristone in 2000.
Many health care providers note that the scientific basis for the current lawsuit is flimsy at best and non-existent at worst. In fact, the two key documents that the plaintiffs relied on in the lawsuit as evidence of the potential harm of mifepristone were recently withdrawn. “These obstructions are politically motivated attacks,” says Srinivasulu. “They have no scientific basis.”
Health experts are also concerned that the case could undermine the FDA's ability to evaluate other drugs. A decision in favor of a small group of doctors “hungry to fight abortion” could call into question the agency's authority to regulate everything from cancer treatments to Tylenol, Cleland said. “It's wild.”
But the new study clearly demonstrates that “the FDA followed the science when it expanded the availability of medication abortion,” Upadhyay says. She hopes the Supreme Court will do the same in its upcoming decision.
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