EXECUTIVE SUMMARY

Providing medication abortion via telemedicine and mail could increase abortion access, according to recent research.

  • Gynuity, a New York City-based reproductive health research organization, is conducting the TelAbortion study, designed to evaluate the use of telemedicine in providing medical abortion to women who have difficulty accessing abortion clinics. It is now available in Colorado, Georgia, Hawaii, Maine New Mexico, New York, Oregon, and Washington.
  • According to the Guttmacher Institute, 17 states currently require the prescribing clinician to be physically present when medication abortion is dispensed. By removing these restrictions, states could implement medication abortion services using a site-to-site model pioneered by Planned Parenthood.

Provision of medication abortion by direct-to-patient telemedicine and mail could increase abortion access, according to recent research.1

Reproductive health research organization Gynuity is conducting the TelAbortion study, designed to evaluate the use of telemedicine in providing medication abortion to women who have difficulty accessing abortion clinics. It is now available in Colorado, Georgia, Hawaii, Maine, New Mexico, New York, Oregon, and Washington. (More information is available at: www.telabortion.org.)

After consulting with an abortion provider by videoconference, qualifying participants receive the necessary abortion medicines by mail. Researchers studied data to determine how well the service model works and whether women are comfortable with this approach.

Each patient held a videoconference with a study clinician and underwent pretreatment lab tests and ultrasound at facilities of her choice. If the patient was eligible for medication abortion, the patient received a package via mail containing mifepristone, misoprostol, and usage instructions. After taking the medications, the participants obtained follow-up tests and a consultation with the clinician by phone or videoconference to evaluate the procedure.

Over 32 months, researchers conducted 433 study screenings and shipped 248 packages. Data show the median interval between screening and mailing was seven days, with no participant taking the mifepristone dosage beyond 71 days’ gestation. Abortion outcomes were ascertained in 77% of cases; 93% had complete abortion without a procedure.

According to follow-up data, one participant was hospitalized for postoperative seizure and another for excessive bleeding; 27 women had other unscheduled clinical encounters, 12 of which resulted in no treatment. More than 60% of women completed satisfaction questionnaires at study exit; all were satisfied with the service.1

Phone Access May Provide Counseling

Telehealth capabilities may help facilitate the delivery of health-related information, education, and services when it comes to medication abortion. Results of a new study indicate that it may minimize the burdens of cost, travel, and time associated with attending two in-person visits in Utah.2

Currently, Utah requires patients seeking abortion to wait at least 72 hours between attending mandatory information sessions and undergoing an abortion. Planned Parenthood Association of Utah began offering telemedicine in 2015 as a way for patients to attend such state-mandated information visits.

Researchers conducted in-depth interviews with women who attended informational visits via telemedicine. Overall, women reported that telemedicine was easy to use and believed the nurse who provided the education was attentive to their emotions over video. A minority of women said they would have preferred an in-person visit, but the burdens of attending in person led them to choose the telehealth option.

While telemedicine does not remove the logistical and financial barriers women experience with Utah’s 72-hour waiting period and two-visit requirement, it may ease some burdens of the requirements, researchers concluded. States that require in-person information sessions may wish to seek similar programs, researchers stated.2

According to the Guttmacher Institute, 17 states currently require the prescribing clinician to be physically present when abortion medication is dispensed.3 By removing these restrictions, states could implement medication abortion services using the site-to-site model used by Planned Parenthood.

Planned Parenthood of the Heartland pioneered telehealth access to abortion in 2008, when it began using telehealth at Iowa health centers not regularly staffed by a clinician providing abortion care; now, Planned Parenthood offers such services in at least 10 states.3

Many women are seeking ways to access medication abortion on their own due to their inability to access clinic-based abortion services or personal preference to the convenience and control that comes with self-use. Plan C, plancpills.org, provides public education about how women can safely and effectively manage their own abortions using pills. The website is a project of the National Women’s Health Network.

The website offers information on ways to access the mifepristone/misoprostol form of medication abortion, as well as the misoprostol-only option. A recent review of published medical evidence on use of the misoprostol-only agent for medication abortion suggests that misoprostol alone is an effective, safe, and reasonable option for women seeking abortion in the first trimester.4

REFERENCES

  1. Raymond E, Chong E, Winikoff B, et al. TelAbortion: Evaluation of a direct to patient telemedicine abortion service in the United States. Contraception 2019; Jun 3. pii: S0010-7824(19)30176-3. doi: 10.1016/j.contraception.2019.05.013. [Epub ahead of print].
  2. Ehrenreich K, Kaller S, Raifman S, et al. Women’s experiences using telemedicine to attend abortion information visits in Utah: A qualitative study. Womens Health Issues 2019; May 17. pii: S1049-3867(18)30598-X. doi: 10.1016/j.whi.2019.04.009. [Epub ahead of print].
  3. Donovan MK. Improving access to abortion via telehealth. Guttmacher Policy Review 2019;23-28.
  4. Raymond EG, Harrison MS, Weaver MA. Efficacy of misoprostol alone for first-trimester medical abortion: A systematic review. Obstet Gynecol 2019 Jan;133(1):137-147.