In light of the overturn of Roe v. Wade and the subsequent proliferation of abortion bans and restrictions, telemedicine services for medication abortion (MA) have become more essential. The “abortion pill” typically comprises a combination of two medications, mifepristone and misoprostol, or misoprostol alone. This method of pregnancy termination has seen a significant rise in usage attributed to factors such as reduced stigma, travel convenience, and cost-effectiveness. For patients who live in states where abortions, specifically in-clinic abortions, are illegal, one option is to travel to another state where abortion is legal. If this is not possible, non-profit organizations that mail these medications, such as Aid Access, may be their sole recourse.
As the Supreme Court deliberates on a case brought forth by a coalition of anti-abortion physicians and organizations targeting mifepristone, the threat to abortion rights persists. Their primary argument revolves around safety concerns, particularly since the FDA has increasingly expanded access to mifepristone. For instance, in 2021, the FDA rescinded an in-person dispensing requirement; the challengers to mifepristone argue the FDA made this decision with unreliable and inadequate studies.
Mifepristone stops the pregnancy from growing. Later, misoprostol causes the uterus to cramp and bleed, expelling the pregnancy tissue.
Image Source: ROBYN BECK
A recent study published in Nature by the University of California, San Francisco, investigated the efficacy and safety of telehealth MA while also comparing different follow-up methods: synchronous (via video call) and asynchronous (using secure text messages). The researchers used data from the California Home Abortion by Telehealth study, which tracked patients from three virtual clinics. In total, the study encompassed 4,454 patients for whom the abortion outcome was known.
The study revealed that 97.7% of the medication abortions administered were effective, with no known interventions or ongoing pregnancies reported afterward. These results found were consistent with prior studies of in-person MA, which have reported effectiveness rates ranging from 96-97%. Interestingly, the type of follow-up method did not influence effectiveness. In terms of safety, 99.7% of the abortions did not result in serious adverse events. Only 81 patients (1.3%) visited the emergency department, and one-third of them did not require further treatment.
Naturally, this study had its limitations, including variability among the three virtual clinics included in the dataset. Likewise, the data depended on patients who were able to follow-up and able to participate in surveys, potentially introducing selection bias. Nonetheless, this large-scale study of telehealth-administered medication abortion bolstered existing evidence regarding the safety of mifepristone and the FDA’s regulations, even amidst ongoing legal scrutiny. Thus, telemedicine and mailed pills are a safe and effective option, especially in the light of ongoing legislative threats.
Featured Image: © ChayTee /Adobe Stock
