A recent large-scale study conducted by researchers at the University of California, San Francisco, has found that obtaining abortion pills prescribed through telemedicine and received via mail is as safe and effective as obtaining them through in-person visits to a doctor. The study, which analyzed the experiences of over 6,000 patients from April 2021 to January 2022, reported that this method was approximately 98 percent effective and deemed safe for over 99 percent of patients.
The patients in the study utilized telemedicine abortion services offered by three organizations—Hey Jane, Abortion on Demand, or Choix—which operated in 20 states and Washington, D.C. Published in Nature Medicine on Thursday, the research concluded before the Supreme Court overturned Roe v. Wade, leading to a surge in state-level abortion bans and restrictions. Since then, more telemedicine services have emerged and are being utilized by many patients who find the method more convenient, private, and affordable compared to visiting clinics or doctors, particularly if they need to travel to another state.
The services involved in the study provided prescriptions for pills to patients who were 10 weeks pregnant or less (with one service limiting to eight weeks) and screened them for medical conditions that could render them ineligible, such as ectopic pregnancies or blood-clotting disorders.
In most instances, healthcare professionals from these services, including doctors, nurse practitioners, physician assistants, and midwives, assessed eligibility based on patients’ verbal or written information about their pregnancy and health. This method circumvented the need for ultrasounds, which can be challenging for some patients to access. If there was uncertainty regarding medical eligibility, patients were advised to undergo ultrasounds. Among the 6,034 patients who received pills in the study, 486 underwent ultrasounds and were subsequently prescribed pills, accounting for approximately 8 percent of the total.
Researchers examined the medical records of the services and were able to ascertain abortion outcomes for 4,454 of the patients, which represented three-fourths of the total. An overwhelming majority—4,351 patients, or 97.7 percent—successfully completed abortions using the standard regimen: mifepristone, which halts pregnancy development, followed by misoprostol, administered a day or two later to induce contractions and expel the tissue.
Out of the remaining patients, 85 required additional interventions to complete the abortion process, typically involving extra medication or a suction procedure performed at a medical facility. Among them, 81 sought care at emergency departments, resulting in 15 patients experiencing serious complications. Ten patients needed hospitalization, six received blood transfusions, two were treated for infections, and one underwent surgery for an ectopic pregnancy.
Interestingly, six patients were diagnosed with ectopic pregnancies, a condition that would have rendered them ineligible for the prescribed pills. Research indicates that ectopic pregnancies are not always detectable early, even with ultrasound examinations.
Among the patients who visited emergency departments, 38 percent ultimately required no treatment. Dr. Ushma Upadhyay, a public health scientist at U.C.S.F. and one of the study’s authors, explained that patients may turn to emergency departments due to uncertainty about whether their symptoms are normal. She noted that some patients lack access to guidance and may be hesitant to discuss their abortion experiences with others.
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