Telemedicine abortion improves health equity and is a reliable option for patients who can’t easily get to a clinic, even as Republican legislators in some states have banned the use of telemedicine for medication abortion care.
A study released July 9, conducted by Planned Parenthood Federation of America with researchers from Ibis Reproductive Health and Advancing New Standards in Reproductive Health (ANSIRH) at the University of California San Francisco (UCSF), finds outcomes for medication abortion via telemedicine are comparable to in-person medication abortion.
“This study confirms what we know firsthand: Telemedicine can improve health equity by ensuring that more people have access to the care they need—including abortion—in a timely manner by reducing the barriers that make it harder for people to get care, including securing transportation, childcare, and time off work,” said Dr. Julia Kohn, national director of research at Planned Parenthood Federation of America and the lead author of the study. “As access to abortion shrinks across the country, telemedicine is one strategy for expanding patients’ access to safe, legal abortion, including for those living in remote or rural areas.”
Medication abortion provided by telemedicine has been proven to be safe and effective, yet lawmakers in several states continue to prohibit them or pass laws to restrict the practice due to erroneous claims about its safety. Arkansas, Idaho, Mississippi, and Utah are among the states that have telemedicine abortion bans and restrictions in place.
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Medication abortion, using a combination of mifepristone and misoprostol pills, has been legal in the United States for almost two decades and is supported by the American College of Obstetrics and Gynecologists (ACOG), National Abortion Federation (NAF), and Planned Parenthood, which began offering the service in 2008 at Iowa health centers not always staffed by clinicians.
“The shortage of providers and clinics makes abortion difficult to access in the United States,” Dr. Daniel Grossman, director of ANSIRH and a co-author of the study, said in a statement. “Telemedicine extends the reach of providers to increase the availability of services.”
Medication abortion has traditionally been an in-clinic service, but barriers to access in recent years have led to the increasing use of telemedicine as “an effective and important tool for expanding access to care, improving health outcomes and reducing health care costs,” according to the Guttmacher Institute, a research and policy organization working to advance sexual and reproductive health and rights.
Six states have only one clinic providing abortion care; 27 major cities and much of rural areas rest in so-called abortion deserts, where people live more than 100 miles away from an abortion provider, Amnesty International reported in June.
A National Academies of Science, Engineering, and Medicine panel in 2018 concluded a health-care provider does not need to be present during a medication abortion.
In 14 states, Planned Parenthood offers medication abortion via site-to-site telemedicine. It mimics the in-person model by having a patient visit a health center that may not have a clinician on staff. The patient can then videoconference with a clinician at another health center who can answer questions and remotely authorize the medication.
Medication abortions provided via telemedicine have the same health outcomes as medication abortions provided at a clinic, the study, published this month in the journal Obstetrics & Gynecology, confirmed.
With Roe v. Wade under threat and Republican-majority legislatures passing near-total abortion bans in many states this year, Grossman said there is a need for more access to safe, legal abortion, not less. “While medication abortion via telemedicine is not the solution to these abortion bans, this study shows that it is one way to help more people get the care they need when they need it,” he said in the release.
The study indicates that telemedicine abortion is “a safe and effective way of ending an early pregnancy, with very rare complications” and can provide the same quality of health care patients receive at a health center, Kohn said.
Previous studies have shown telemedicine abortion to be effective and a boon to abortion access. A 2018 study by ACOG examined the effectiveness of TelAbortion, a direct-to-patient telemedicine abortion service offered by Gynuity Health Projects, a nonprofit reproductive health organization, which allowed patients to connect with physicians from their homes. A study published in June examining the service offered in five states found telemedicine abortion to be “safe, effective, efficient, and satisfactory” and having “the potential to increase abortion access by enhancing the reach of providers and by offering people a new option for obtaining care conveniently and privately.”
Many self managing medication abortion by buying the pills online through providers like Aid Access, which has been attacked by anti-abortion groups and congressional Republicans. Last year, Aid Access received 21,000 requests from people in the United States, the Guardian reported. The majority of these requests came from people who live in states with hostile abortion policies.
“Anti-abortion politicians have been passing burdensome laws to curtail access to safe, legal abortion for decades, including medically unnecessary restrictions on medication abortion via telemedicine,” Kohn said. “There is no scientific basis for these restrictions, as medication abortion has been safe and legal in the U.S. since the FDA approved its use nearly 20 years ago.”
The latest study examined the electronic health records of nearly 6,000 patients receiving medication abortion either through telemedicine or in person at 26 Planned Parenthood health centers in Alaska, Idaho, Nevada, and Washington.
“In many ways, this study does reaffirm what we already know: Medication abortion via telemedicine is safe and effective at ending an early pregnancy,” Kohn said.