Medication abortion administered via telehealth is largely safe and effective, according to a research letter published in JAMA Network Open.

TOP LINE DATA

The study of 110 patients between October 2020 and January 2021 found 95% had a complete abortion without any additional medical intervention. 

Five patients needed medical care to complete the abortion, and two of them were treated in an emergency room. No patients reported major adverse outcomes.

HOW IT WAS DONE

Medication abortion usually requires two medications, mifepristone and misoprostol. The FDA previously required mifepristone to be administered in a medical office, clinic or hospital to avoid complications, but that restriction was lifted in July 2020 due to the COVID-19 pandemic. 

Although the Supreme Court briefly overturned the FDA’s decision in January 2021, the Biden administration decided in April to allow the drug to be delivered by mail for the duration of the pandemic.

During that July-January window, a virtual clinic called Choix performed medication abortions in California, and researchers examined the procedure’s safety and efficacy. Patients needed to have a pregnancy duration of fewer than 70 days with no contraindications to mifepristone or misoprostol.

A mail-order pharmacy sent the medication to patients, and they received follow-up care three times: the first time when the pills were given, then three days after patients took the medication and finally four weeks later with a home pregnancy test.

The medication abortion was provided for 141 patients, and the researchers received outcome data for 110 patients.

In terms of conflicts of interest, one researcher reported receiving personal fees from a mifepristone distributor, though not one used for this study. The researcher also participated in an FDA-mandated expert hotline.

THE BACKGROUND

Other studies have shown medication abortions conducted via telehealth are safe and effective, and they have similar results as their in-person equivalents. 

During the pandemic, when healthcare moved to telehealth to reduce in-person contact, access to abortion in general was debated in some states. According to a report by the Kaiser Family Foundation, 12 states issued policies that attempted to limit access, like considering abortion “non-essential” medical care.

The Guttmacher Institute reports 19 states require that the clinician providing the medication abortion be physically present when the medication is given, prohibiting the use of telemedicine.

IN CONCLUSION

“This study is small with some loss to follow-up, and thus some adverse events and ongoing pregnancies may have been undetected,” the researchers wrote. “However, it reflects real-world data, which increases generalizability. This study provides preliminary evidence that suggests medication abortion care, administered by telehealth and delivered via mail, is feasible, safe and efficacious.”