Online access to abortion pill may be safe alternative to clinics

(Reuters Health) - Women who don’t have access to reproductive health clinics can safely use telemedicine services to consult with a doctor and get drugs to terminate their pregnancy without surgery, suggests a study of Irish women.

About one quarter of the world’s population lives in countries with highly restrictive abortion laws and where women may resort to unsafe methods to end pregnancies. This results in an estimated 43,000 deaths every year, researchers write in The BMJ.

The current study focused on 1,000 women who used an online telemedicine service to get medical abortions in the Republic of Ireland and Northern Ireland, where abortions are illegal in most circumstances.

About 95 percent of the women reported successfully terminating their pregnancies without surgical intervention using medication they received in the mail after providing their medical details and consulting with a trained helpdesk team on how to use the drug. No deaths were reported, and less than 3 percent of the women had complications that required treatment like antibiotics or blood transfusions.

“The results provide the best evidence to date that medication abortion conducted entirely outside the formal healthcare setting using online telemedicine can be highly effective and safe,” said lead study author Dr. Abigail Aiken, a researcher at the University of Texas at Austin.

All of the women in the study got abortion pills through Women on Web (WoW), a nonprofit organization that provides access to medical abortions early in pregnancy for women who live in countries where access to safe abortion is limited.

“While Women on Web only provides medication abortion through online telemedicine in countries where abortion is restricted, the findings of our study suggest that this model may be much more widely applicable,” Aiken said by email. “As long as a woman does not have a contraindication to medication abortion (there are a few of these, but they are rare) and her pregnancy is at a gestational age appropriate for the approved use of the medications in her country, medication abortion using a reputable online telemedicine service may be an appropriate option if she needs or prefers it.”

Surgical abortions require in-person clinic visits, but many abortions are now done with medication and a growing number of women are getting pills by consulting with doctors online even when they live in places where abortion is legal.

In the U.S., medication abortions are typically performed before 10 weeks of pregnancy with two drugs – mifepristone and misoprostol – that can be self-administered at home. Healthcare providers can use telemedicine to interview patients and assess potential safety issues by reviewing lab test results and ultrasounds before prescribing medication.

In a typical two-step medical abortion regimen, women first take mifepristone. This pill works by blocking the hormone progesterone, which causes the lining of the uterus to break down and makes it impossible for the pregnancy to continue. Then, a day or two later, women take misoprostol, which causes the uterus to empty.

Women may be advised to have a clinic visit afterwards to confirm that the pregnancy was successfully terminated. In rare cases when ultrasound or a blood test shows the medical abortion didn’t succeed, women require surgical abortions.

In the study, 93 women, or about 9 percent, experienced a symptom that they were told required medical attention, and most of the women followed advice to visit a clinician in person.

One limitation of the study is its reliance on women to accurately recall and report any side effects or problems, the authors note.

Still, women should be reassured by the results, said Dr. Wendy Norman, a researcher at the University of British Columbia in Vancouver who co-wrote an accompanying editorial.

“When a woman has access to see a clinician in person to obtain a medical abortion, that is the preferred method,” Norman told Reuters Health by email. “In areas where medical abortion providers are not available, or areas where abortion is legally restricted, access to a qualified clinician via telemedicine provides a reasonable alternative to discuss the current pregnancy in the context of a woman’s general health and health history, consider available options for her pregnancy, and to provide management of a medical abortion from start to finish if desired.”

SOURCE: and The BMJ, online May 16, 2017.