New research confirms previous studies in demonstrating the safety and efficacy of medication abortion pills. Studies also show there is strong desire for this option among people seeking an end to their pregnancy.1
Telemedicine for abortion care has been expanding for four years, starting when the U.S. Food and Drug Administration (FDA) rolled back in-clinic rules because of the COVID-19 pandemic, says Emily Godfrey, MD, MPH, lead study author and an associate professor of family medicine and an OB/GYN at the University of Washington School of Medicine.
More than half of all abortions in the United States involve medication. In Washington, that figure is just under 60%, according to Godfrey.
“Since the U.S. Supreme Court overturned Roe v. Wade in the Dobbs decision last June, the use of telemedicine for medication abortion services has increased by 137%, according to the Society of Family Planning WeCount Study,” Godfrey explains.2
Patients who sought telemedicine consults were more likely to have undergone a prior abortion and tended to live outside the metro areas when compared with in-person patients.
Godfrey and colleagues conducted in-depth interviews in a convenience sample of patients who recently sought face-to-face or telemedicine medication abortions at a clinic in Washington state. Their goal was to learn more about clinician/physician communication.
“It’s a given that over the last 23 years, patients have had to go into a clinic to get the abortion pill, so we assumed they know how to give care in that manner,” Godfrey says. “Our question was, ‘Does communication need to shift when you do telemedicine?’”
Previous literature about telemedicine suggested patients do not feel they can connect with providers as they would with in-person visits, Godfrey says.
“They’re advised to work on lighting and slowing down to be sure there’s more empathy conveyed to patients,” Godfrey explains. “That was the rationale and reasoning for our study to look at telemedicine and compare it to in-clinic care.”
Godfrey and colleagues studied these factors:
- Setting of the encounter, whether it was direct-to-patient telemedicine, which means the patient could be in a setting of their choosing;
- Patient’s interaction, such as whether the patient felt respected and free of coercion;
- Communication of information, addressing how information about what to expect was conveyed to patients;
- Health outcomes, including how satisfied patients were with the care they received at the clinic and after the visit.
“When pills were shipped to the patient, did they understand what to do, and could they follow instructions?” Godfrey says.
Some states, such as Illinois, have been seeing a large influx of out-of-state patients. So far, that has not happened in Washington, she notes.
According to a WeCount chart, the abortions increased by 42% in Illinois between April 2022 and March 2023. Washington recorded a 16.5% increase in that same period.3
Before COVID-19 and the Dobbs decision, mpdy abortions occurred in abortion clinics. Then, with COVID-19, providers began offering telemedicine in various healthcare domains, including mental health, wellness visits, and other areas.
By expanding telemedicine to abortion care with use of abortion pills, clinics can be ready to handle increased numbers of patients from out of state, and patients might not have to wait two to four weeks for an appointment.
“That’s how long people were waiting during the pandemic, from 2021 to 2022,” Godfrey says. “The clinic had to limit patients and was doing social distancing in medical facilities.”
Patients typically do not want to wait for care. With abortion care, the timing is especially important.
“This is telling primary care clinics to take care of their own patients by offering medication abortion,” Godfrey explains. “And it’s telling them it’s not rocket science, and if they’re providing patient care in the clinic, they can apply those principles to telemedicine, and patients will be very satisfied.”
Telemedicine has multiple advantages for patients and providers, including discretion.
“A lot of patients mentioned in their interviews that they were afraid of running into someone in the waiting room,” Godfrey says. “It’s more discreet for providers; protestors won’t know who to target.”
Before COVID-19, patients were required to visit a clinic and undergo various tests and exams, but none of the evidence supported the idea that those exams improved care. Now, providers know that patients can do well without an in-person visit and without additional tests.
The next step would be for the FDA to ease regulations on providers who prescribe mifepristone and misoprostol.
“The FDA has been extremely conservative,” Godfrey says. “The amount of evidence that demonstrates the safety of mifepristone is unprecedented. It’s an increasingly safe medication.”
Canada enacted similar restrictions when the nation first approved mifepristone in 2015, but they lifted the restrictions after listening to several years of evidence about its safety, she adds.
“They have shown that family doctors throughout the nation in very rural areas can provide the care that patients are needing and requesting, and it’s made a dramatic difference to access in that country,” Godfrey says. “As the Southeast and Midwest ban abortion in the United States, people have to travel several hundred miles each way to pick up a pill.”
Physicians need to understand their patients’ needs and think creatively on how to best meet those needs.
“What’s happening in states where abortion is illegal is you’re going into a job where you are not just thinking about the needs of your patients — you’re thinking about the needs of the legislators or potentially people in your clinic who might report you,” Godfrey notes.
Physicians have to worry about investigations, audits, and being reported by patients, staff, and friends. Anti-abortion laws have taken an already challenging job and made it much more complex.
“It’s traumatic, it goes against how we were trained, and it goes against our ethics,” Godfrey says. “It will lead to horrible burnout, and I’ve heard of high-risk OB/GYNs leaving Idaho. People in those states are going to suffer. Pregnant women in those states are going to suffer.”
REFERENCES
- Godfrey EM, Fiastro AE, Ruben MR, et al. Patient perspectives regarding clinician communication during telemedicine compared with in-clinic abortion. Obstet Gynecol 2023;141:1139-1153.
- Society of Family Planning. #WeCount Report, April 2022 to December 2022. April 11, 2023.
- Society of Family Planning. Change in number of abortions by state. July 19, 2023.
New research confirms previous studies in demonstrating the safety and efficacy of medication abortion pills. Studies also show there is strong desire for this option among people seeking an end to their pregnancy.
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