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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.
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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: http://bit.ly/2rY2FQL and http://bit.ly/2qEP9xs The BMJ,
online May 16, 2017.
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