Abortion Pills Obtained From Virtual Clinics Are Safe and Effective
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In-person exams often aren’t necessary for women to safely get a medication abortion, a new study of telemedicine visits suggests.
“Medication abortion overall is extraordinarily effective and safe,” says Jennifer Karlin, MD, PhD, an assistant professor in family and community medicine at the University of California in Davis, who wasn’t involved in the new study. In fact, the outcomes seen with virtual visits, texting, and mailing medication in this study appeared even better than what typically happens with in-person care, Dr. Karlin says.
All the patients in the study received abortion pills after video visits or text messaging with virtual clinics. Patients who were beyond the nine-week gestational limit for the virtual clinics or who had risk factors for ectopic pregnancy (when the fertilized egg develops outside the uterus) were referred for in-person care and excluded from the study.
It’s possible that up to 18 percent of patients might be deemed ineligible for telehealth abortion pills because of the so-called “no test” criteria used in the study to screen patients who didn’t get in-person exams or ultrasounds, Karlin says.
“This is likely because the no-test abortion is screening out more people than necessary,” Karlin says. “Making the criteria less restrictive would help include that 18 percent, a large percentage of whom would have an effective and safe medication abortion.”
Serious Side Effects From Medication Abortion Are Rare
Among the patients included in the study, only 15 people experienced serious adverse events. This included six people who had ectopic pregnancies and 10 individuals who were hospitalized.
Even though this suggests that a small proportion of people have complications after receiving abortion pills through the mail, the results still point to the safety and effectiveness of this method of pregnancy termination for the vast majority of people, the study authors concluded.
More than half of abortions today are done using medication — a regimen that includes the drugs mifepristone and misoprostol.
When the COVID-19 pandemic hit, the FDA temporarily lifted this requirement, allowing women to get abortion pill prescriptions from telemedicine visits and receive the medications by mail instead of going to a pharmacy. This not only helped women get needed medical care during the pandemic, it also enabled researchers to collect evidence about the safety and effectiveness of offering medication abortions without in-person visits.
Supreme Court Case Puts Self-Managed Abortion Access at Risk
Now, however, the U.S. Supreme Court is considering whether to require the FDA to rescind rules that have made it easier for people to access medication abortions.
“Each person should decide which is right for them, a medication or a procedural abortion,” says the lead study author, Ushma Upadhyay, PhD, MPH, a public health scientist with Advancing New Standards in Reproductive Health (ANSIRH) at the University of California San Francisco.
Given a choice, there will always be people who prefer to see a doctor, regardless of whether they’re getting pills or a procedure, and there will also always be people who’d prefer to manage their abortion as much on their own as possible, says the sex educator and self-managed abortion advocate Lux Alptraum.
“Even if there were no legal obstacles to abortion care, there’d still be people who’d want to take pills at home alone and people who’d want to go into a clinic,” says Alptraum, who wasn’t involved in the new study. “Legal restrictions are always going to hit procedural abortions harder than medication abortions because it is much easier to safely distribute abortion pills in regions where abortion is criminalized than to perform safe procedural abortions in those regions.”
As long as it remains legal, medication abortion and virtual visits for prescriptions are likely to become increasingly common, Dr. Upadhyay says. That’s because there are many reasons why people choose this option over in-person visits, including added privacy, shorter wait times, and the ability to avoid travel and manage the abortion at home.
“I hope this study will spread awareness that one can have an abortion with pills alone and that it can be done through telemedicine, without an in-person visit,” Upadhyay adds. “I hope this study helps to reduce some of that uncertainty and makes people feel more comfortable using these services.”
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