By Rebecca Bowers

EXECUTIVE SUMMARY

As restrictions of clinic access to abortion mount, some women may seek internet access to services. Research indicates that women seeking medication abortion drugs online choose to do so because of barriers to clinic access in states with and without restrictive abortion laws. The choice also can happen when women prefer to self-manage their abortion rather than receive clinical care.

  • For some abortion providers, telemedicine has offered a chance to extend access to medication abortion. A 2014 practice bulletin from the American College of Obstetricians and Gynecologists stated that telemedicine can be used to provide the procedure safely and effectively with a high level of patient satisfaction.

Just-published research provides insight about why women choose online access to medication abortion.1

Researchers at the University of Texas at Austin LBJ School of Public Affairs conducted anonymous interviews with 32 people from 20 states who sought abortion medications online. Through the interviews, scientists found that those seeking medication abortion drugs online choose to do so because of barriers to clinic access in states with and without restrictive abortion laws. The choice also can happen when women prefer to self-manage their abortion rather than receive clinical care.1

Although online options may offer either information or medications, there is no site that offers both, respondents told researchers. The lack of trusted online options may lead women to delay care or look to ineffective or unsafe alternatives, scientists say.

“We know that medication abortion is extremely safe and effective when carried out with the correct doses of medications, clear instructions and information about what to expect, and a reliable source of support and aftercare,” said Abigail Aiken, MD, MPH, PhD, an assistant professor of public affairs and a fellow of the Richter Chair in Global Health Policy at the LBJ School of Public Affairs at the University of Texas at Austin, in a press statement. “Unfortunately, most current online options leave these needs unmet.”

Restrictions Lead to New Avenues

In 2000, the Food and Drug Administration (FDA) approved mifepristone for use in early nonsurgical abortion. Since that time, states have enacted various restrictions of its use. Although the World Health Organization and the National Abortion Federation recommend that midlevel providers, such as advanced practice nurses and physician assistants, can provide medication abortion safely, many states limit provision of the drug to physicians only.

In 2016, the FDA issued new labeling for mifepristone, which lowered the recommended dosage of the drug, extended the timeframe for when a woman can take the pill, and reduced the number of provider visits.

For some abortion providers, telemedicine has offered a chance to extend access to medication abortion. A 2014 practice bulletin from the American College of Obstetricians and Gynecologists stated that the procedure can be provided via telemedicine safely and effectively and with a high level of patient satisfaction.2

A recent study looked at patients from Planned Parenthood of the Heartland in Iowa who received a medication abortion either via telemedicine or in person from 2008 to 2015. Of the nearly 20,000 patients included in the study, just 49 complications were reported. Data indicate there was no difference in the complication rate between women who received in-person care and those who used telemedicine.3

Women who received abortion care via telemedicine received the same level of evaluation as those who received in-person care, including having an ultrasound, which is viewed remotely by the physician. Physician visits were held through secure videoconference, and medication was dispensed remotely following physician evaluation. Women returned to the clinic about one week later for confirmation of successful procedures.

According to the Guttmacher Institute, 19 states currently require the clinician to be physically present when providing a medication abortion. This restriction prohibits using telemedicine for medication abortion.

“This study included a large number of patients, so we can definitively conclude that telemedicine provision of medication abortion is not associated with a higher risk of complications compared with in-person provision,” notes study co-author Daniel Grossman, MD, director of Advancing New Standards in Reproductive Health at the University of California, San Francisco. “These findings add to our previous research demonstrating that telemedicine medication abortion was just as effective as meeting with the physician in person, and satisfaction was also high among the women studied.”4

Research Focuses on Access

Scientists affiliated with Gynuity, a reproductive health research organization, are conducting the TelAbortion Study, which is designed to evaluate providing medical abortion via telemedicine to women who have difficulty accessing abortion clinics.

After participating in a consultation with an abortion provider by videoconference, qualifying participants receive the necessary abortion medicines by mail. Investigators are collecting information to understand how well this model works and whether patients are satisfied with receiving abortion care in this way.

The study now is open to women in Hawaii, Oregon, Washington, New York, and Maine, and organizers hope to expand its access to other states.

Planned Parenthood affiliates in 10 states currently offer telemedicine abortion. Telehealth services also are available at a Whole Woman’s Health clinic in Illinois and at Maine Family Planning in Maine.

REFERENCES

  1. Aiken ARA, Broussard K, Johnson DM, Padron E. Motivations and experiences of people seeking medication abortion online in the United States. Perspect Sex Reprod Health 2018; doi: 10.1363/psrh.12073. [Epub ahead of print].
  2. American College of Obstetricians and Gynecologists. Practice bulletin no. 143: Medical management of first-trimester abortion. Obstet Gynecol 2014;123:676-692.
  3. Grossman D, Grindlay K. Safety of medical abortion provided through telemedicine compared with in person. Obstet Gynecol 2017;130: 778-782.
  4. Grossman D, Grindlay K, Buchacker T, et al. Effectiveness and acceptability of medical abortion provided through telemedicine. Obstet Gynecol 2011;118:296-303.