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Study Supports Safety, Effectiveness of Telemedicine Abortions

Conducted in Ireland and Northern Ireland by a global program supporting abortion access, the study finds that telemedicine abortions are both effective and safe, and can benefit women in remote and underserved regions.

Source: ThinkStock

By Eric Wicklund

- A three-year study in Ireland and Northern Ireland has apparently proven the effectiveness and safety of abortions by telemedicine.

The study, published online in the UK-based BMJ by researchers from the University of Texas at Austin, uses data gathered by Women on Web (WoW), a global program offering access to abortion by telemedicine services in countries where access is limited.

Roughly 25 percent of the abortions performed in the U.S. are non-surgical, or medical abortions. The process can be paired with a telemedicine platform in two ways: a physician can examine a patient via telemedicine, then issue a prescription for mifepristone and misoprostol to the patient to terminate the pregnancy; or a remote physician can examine a patient who’s at a clinic, then issue instructions to clinic personnel to dispense the drugs from a locked cabinet that is remotely opened by the doctor.

In the WoW study, women in Ireland and Northern Ireland with an unplanned pregnancy of 10 weeks or less were given an online exam, then received their prescriptions by mail, along with instructions on how to take the drugs and where to access support or more information.

In all, 1,636 received medications between January 2010 and December 2012, 1,023 used the medications and 1,000 provided follow-up information used in the study. Of those 1,000 women, almost 95 percent reported that their pregnancy was successfully terminated, while 45 women (4.5 percent) needed clinical intervention.

READ MORE: The Evolving Role of mHealth in Medication Management and Adherence

According to lead researcher Abigail R.A. Aiken, PhD, from UTA, the study not only proved that abortion by telemedicine is safe and effective in a region where access to abortion services is restricted, it also helped the women identify when they had an adverse reaction that required clinical intervention.

“Our results have important implications for the perception of abortion self-sourced outside the formal health system using online telemedicine,” she concluded in the BMJ article. “Firstly, they clearly show that not at all abortions taking place outside the law are unsafe abortions. Secondly, they add an important dimension to existing evidence that women themselves report abortion through online telemedicine as a positive experience with benefits for health and wellbeing.”

“Millions of women worldwide live in countries where self-sourced medical abortion is a potentially lifesaving option, and strengthening services outside the formal healthcare setting could be a vital component of strategies to reduce maternal mortality from unsafe abortion,” she added. “Finally, given the trajectory of abortion policy in Europe and the US, the visibility and importance of self-sourced medical abortion will continue to increase. There are already reports of women seeking abortion outside the formal healthcare setting in the US. Investigating women’s experiences, preferences, outcomes, and unmet needs in various settings is a critical goal for future research.”

With Texas Gov. Greg Abbott expected to soon sign new telehealth legislation that would ban telemedicine abortions, roughly 21 states have banned the procedure, and others have set strict limits. But other states see telemedicine as an avenue to improved healthcare access for women in remote and underserved locations.

Earlier this year, Idaho lawmakers amended legislation banning abortions by telemedicine after coming out on the losing end of a lawsuit filed by Planned Parenthood’s regional chapter. In Utah, lawmakers stripped out language in a proposed bill before it came to a vote, saying they didn’t want healthcare and politics to clash.

READ MORE: The Benefits and Challenges of Telehealth for Specialists

Last August, a study conducted by researchers at the University of California-San Francisco found that women in Alaska who had access to abortion services via telemedicine were able to get care closer to home and in a more timely manner, and were better able to choose how they wanted an abortion.

The study, led by Massachusetts-based Ibis Reproductive Health and UCSF’s Advancing New Standards in Reproductive Health (ANSIRH), didn’t report any impact on the number of abortions provided or notice any clinical benefits. But researchers said the telemedicine platform expanded the opportunities for women to receive timely care, as opposed to having only one or two days a month when they might be able to see a doctor in person at a clinic.

“This study adds to the robust evidence base that has clearly documented both the acceptability and large potential benefits of telemedicine provision of medication abortion,” Kate Grindlay, an Ibis Reproductive Health associate and lead author on the study, said in remarks accompanying the study. “Our results were in line with other research that has shown that this service can be easily integrated into other healthcare offered at a clinic, can help women access the services they want and need closer to home, and allows providers to offer high-level care to women from a distance.”


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