On September 28, 2000, the Food and Drug Administration (FDA) approved mifepristone, also known as RU-486, the early abortion pill. This was an exciting moment for any woman looking for a non-surgical option to safely and effectively end her pregnancy. This was an especially notable day for the Reproductive Health Technologies Project, since the fight to bring mifepristone to market is the reason that we exist and is still a big part of our legacy as we celebrate our twentieth year.
Medical abortion consists of the administration of mifepristone and misoprostol. Mifepristone is a pill that terminates an early pregnancy, up to 63 days or 9 weeks after the first day of a woman’s last period. When followed by administration of misoprostol, a prostaglandin that induces uterine contractions, mifepristone ends an unwanted pregnancy approximately 97% of the time.
Medical abortion is non-invasive, more private than surgical abortion, and carries no risk of uterine perforation (a hole in the wall of the uterus). It is also different from surgical abortion in that a woman may complete the abortion in the privacy and comfort of her own home.
While the mission of RHTP has expanded over the years, mifepristone education and advocacy is still an integral part of our work today as we continue to defend against attempts to limit access to early abortion care.
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Tele-medicine administration of medical abortion is a relatively new practice in the United States with great potential to reach underserved women with abortion care. Unfortunately, political conservatives seek to restrict women’s ability to utilize this important service.
Tele-medicine is the use of telecommunications technology to provide health services, exchange health information, or manage patient care. For example, a physician who is away on travel can monitor a patient’s vital signs and can connect with that patient via phone or video conference if something is amiss. Telemedicine can also connect patients in underserved communities to specialists, such as abortion providers.
In the United States, where 87 percent of counties have no abortion provider and health services are scarce in both rural and some urban areas, the use of technology to provide care is not a luxury–it is a necessity.
Using available technology to provide abortion services is particularly important for women who experience challenges accessing safe abortion such as having to travel long distances to obtain care, spending precious time and money. Women deserve to have access to abortion services in their communities and until underserved areas have the infrastructure to offer this vital service, telemedicine can serve to fill that gap.
Data show that telemedicine provision of medical abortion is not just acceptable to women—in some cases it may be the preferred option.
A recent study by Daniel Grossman, MD and colleagues demonstrated both high efficacy and high satisfaction among women who received a medical abortion using telemedicine video conferencing. In this study, a prescribing physician provided counseling via a secure video conference and then granted access to a locked drawer containing mifepristone and misoprostol used for medical abortion. The physician observed the patient ingest the mifepristone pill and answered any questions. Women receiving care via telemedicine reported greater overall satisfaction with their experience than women receiving care face-to-face and had similar rates of successful abortion.
One patient described her video conference experience as “like being in the room with [the provider]” while another said it was “better than face to face” interaction with a provider. Other women expressed confidence in the physician’s ability to provide care via video conference, with one patient stating, “I trusted the doctor, that she knew what she was doing.”
It’s clear that women want convenient access to providers they trust for their health care. Unfortunately, politicians are trying to make abortion care even more difficult to access.
In April of this year, Wisconsin Governor Scott Walker signed a bill into law banning the use of tele-medicine for medical abortion, restricting the ability of providers to reach women with the care they need. At the federal level, U.S. Representative Steve King introduced legislation this summer that would ban federal tele-medicine grants from going to clinical providers offering tele-medicine abortion.
Decisions around expanding access to tele-medicine and abortion should be driven by scientific evidence, not politics. When Minnesota Governor Mark Dayton vetoed a bill that would have banned tele-medicine administration of medical abortion, he exemplified how putting science before politics leads to decisions that meet constituent needs.
Tele-medicine has the potential to create access where there is none, provide care where it would not be provided otherwise, and reduce inequalities in access by reaching the underserved. Tele-medicine enhances patient care and bridges gaps between a woman and her care provider.
So, why are our politicians trying to withhold safe abortion services from women who may need them? As we celebrate 12 years of access to this important technology, innovative service delivery may be the perfect anniversary gift for American women.