Telehealth medication abortion ramped up quickly after the Food and Drug Administration (FDA) decided in 2021 to remove the requirement that the drug only be dispensed at in-person facilities.
Researchers began studying the safety and effectiveness of telehealth medication abortions in 2021 and concluded in 2022 before the U.S. Supreme Court decision to overturn Roe v. Wade. The recently published results showed that telehealth medication abortions are safe, with outcomes of 99.8% without serious adverse events.1
“Several startups jumped in, some of the first providers that jumped into the scene after the FDA decision,” says Ushma Upadhyay, PhD, MPH, lead study author and an associate professor in residence at UC San Francisco. “We asked them if we could receive medical records data on their patients to evaluate safety and effectiveness on this model of care. When the FDA removed this requirement, it was a temporary move for the pandemic only, and we thought it was important to document the safety and effectiveness to inform the decisions when they revisited the decision.”
The safety and effectiveness of telehealth prescribing were equivalent to the safety and effectiveness of medication abortion dispensed in person. “We looked at the rates published in the FDA label and compared it to those safety and effectiveness rates,” Upadhyay explains. “Clinics had two follow-up interactions with patients. First, they checked in three to seven days after they took medications to make sure they were having expected symptoms of uterine contractions and dispelling it.”
Then, about four or five weeks after the abortion, patients took a pregnancy test.
“We only worked with U.S.-based providers that were sending medications to patients in the states where telehealth is legal — about 20 U.S. states and Washington, DC,” she says. “Among the patients we recruited to complete surveys, 1,600 completed the surveys.”
The supplementary surveys asked patients about their reasons for using telehealth, the drawbacks, and what they liked most about that method.
“Forty-three percent said they would not be able to get a timely abortion [without telehealth],” Upadhyay says. “Those included young people, people with lower incomes, people in rural areas, and those living over 100 miles from an abortion clinic.”
Upadhyay notes that those surveyed also said their primary reasons for choosing telehealth were greater privacy, shorter waiting times to obtain medications, and the comfort of staying at home. “A common drawback was initial uncertainty about whether the service was safe or legitimate,” Upadhyay says. “It was early on in the provision of care, and many people had not heard about telehealth. I suspect some people still do not know they no longer need to go to a clinic to get an abortion. As more people learn about this option, that drawback will reduce.”
Even if the Supreme Court rolls back the telehealth part of the FDA’s approval of mifepristone, it probably will continue to be provided in the country, Upadhyay says. “People would have to travel to clinics to get medication abortion,” she explains. “Reversal on telehealth would be devasting, especially now, and it would be compounded because of the Dobbs decision.”
Before the high court’s decision, even people in abortion-ban states could receive mifepristone and misoprostol by mail. Some international organizations have and will continue to defy any U.S. restrictions, and providers in six states have shield laws. “The way they do this is the state that has a shield law is protected from subpoenas in the [abortion ban] states,” Upadhyay explains. “The providers cannot travel [without risk] to any state with abortion bans or restrictions, so that is a concern. There also is potential risk for the patients who are receiving these abortion pills by mail.”
Preliminary data by groups collecting information on legal repercussions of medication abortion have found that the most common way law enforcement learn about self-managed abortion is through healthcare providers when patients visit a provider with symptoms or concerns, Uphadyay says. Even if a woman reports that she is having a miscarriage, there is a risk that someone in the clinic or hospital will report her to the police, as was seen with the Ohio case involving Brittany Watts, who was charged with felony abuse of a corpse after a miscarriage at home. The grand jury declined to indict her. But this was several months after she suffered from the trauma of a miscarriage, arrest, and having her name and personal life aired in international news coverage.2
“I have not heard of any reports of patients being prosecuted based on findings from the mail,” Upadhyay says.
Another option for women if the Supreme Court only rolls back the telehealth part of mifepristone’s approval is for the FDA to stop requiring additional certification of providers and pharmacies dispensing abortion pills. This could lead to more primary care providers prescribing mifepristone to patients. That would at least ease the burden in states that protect abortion rights.
“There’s no public health reason to require additional certification from those providers and pharmacies,” Upadhyay says. “It should be treated like any other prescription medication.”
REFERENCES
- Upadhyay UD, Koenig LR, Meckstroth K, et al. Effectiveness and safety of telehealth medication abortion in the USA. Nat Med 2024;Feb 15. doi: 10.1038/s41591-024-02834-w. [Online ahead of print].
- Young M. Fetal personhood laws give zygotes the same rights as pregnant women. Contraceptive Technology Update. Feb. 1, 2024. https://www.reliasmedia.com/ar...
Researchers began studying the safety and effectiveness of telehealth medication abortions in 2021 and concluded in 2022 before the U.S. Supreme Court decision to overturn Roe v. Wade. The recently published results showed that telehealth medication abortions are safe, with outcomes of 99.8% without serious adverse events.
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