As telemedicine policies expand and evolve across the country, there have been clear variations in how some states view the role of virtual care. One of the most challenging issue some states have taken up is whether to allow the use of telemedicine to prescribe medications that induce abortion, a consideration that has led to lawsuits, or has held up legislation that would otherwise establish necessary, overall telemedicine use guidelines in particular states. For those who are in favor of allowing the use of virtual prescribing of such medications, a recent study demonstrating their safety and effectiveness could help make their case.
In an article published in BMJ yesterday, researchers describe their population-based study on 1,000 women who underwent “self-sourced” medical abortions through a telemedicine service called Women on Web between January 2010 and December 2012. The medication-inducing process – which is referred to as “medical abortion” (as opposed to a surgical procedure), and must be done earlier in the pregnancy – consists of two medications. First taken is progesterone-blocking mifepristone, followed a couple days later by misoprostol. Overall, nearly 95 percent of women studied reported successful results with the medication, and few reported adverse side effects such as the need for antibiotics, surgical intervention or blood transfusions. Nobody died.
“…early medical abortion provided through online telemedicine was highly effective. The reported rate of successful medical abortion compares favorably with the rates of those carried out within the formal healthcare system, both when mifepristone and misoprostol are administered in clinic and when mifepristone is administered in clinic and misoprostol is taken at home,” the researchers write. “The reported prevalence of adverse events is low, and, critically, when women reported experiencing symptoms of a potentially serious complication, almost all reported seeking medical attention as advised.”
While the research took place in Ireland and Northern Ireland, it is notable because surgical abortions are not available through the formal healthcare system there except in a few restricted circumstances. This is similar to many other parts of the world, and telemedicine isn’t an option for many women across American who are seeking abortion-inducing medication. According to the Guttmacher Institute, a research organization focused on reproductive health rights, 19 states require clinicians providing abortion-inducing medication be physically present during the procedure, effectively prohibiting the use of telemedicine to prescribe the medication.
“About a quarter of the world’s population lives in countries with highly restrictive abortion laws. Women in these countries often resort to unsafe methods to end their pregnancies,” the Irish researchers write. “Globally, each year an estimated 43,000 women die as a result of lack of access to safe legal abortion services through their countries’ formal healthcare systems. Millions more have complications. Worldwide, the fourth leading cause of maternal mortality is unsafe abortion.”
Safety to women’s health is the main reason opponents cite when bringing it into telemedicine policies in the United States. But those on the other side of the issue argue that safety and effectiveness of medication-induced abortion is an unfounded concern. At the latest study, medical abortions accounted for about 22 percent of all abortions in the United States. The American College of Obstetricians and Gynecologists has supported the use of telemedicine to prescribe and counsel women who wish to choose this process.
States that made amendments to their telemedicine policies to specifically ban the use of virtual prescribing of abortion-inducing medication found themselves slapped with lawsuits on behalf of Planned Parenthood, who called the limitations unconstitutional. Utah was the latest to put such restrictions on telemedicine, although they later removed the language. The amendment was similar to bills that had recently been struck down in other states. Idaho recently stopped banning the use of telemedicine to provide abortion-inducing medication following the settlement of a lawsuit filed by Planned Parenthood, and that organization also won a similar lawsuit in Iowa in 2015 when the state Supreme Court ruled a 2013 rule preventing doctors from administering abortion-inducing medication via telehealth was unconstitutional.
“Our results have important implications for the perception of abortion self sourced outside the formal health system using online telemedicine. 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,” the Irish researchers write. “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. 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.”