A new study has found that ordering abortion pills over the phone, without a face-to-face doctor's consultation, is safe and effective. The results of the research, which analyzed the first 1000 women who obtained the abortion pill through the Tabbot Foundation—a telemedicine provider that launched last year in Australia—were presented at the World Congress on Public Health on Tuesday by associate professor Suzanne Belton.
Women in Australia face the some of the same problems as women in the US: Anti-abortion laws, coupled with the fact that many family doctors decline to perform abortions or prescribe the abortion pill, leave women in geographic areas without abortion clinics with very little options when they experience an unwanted pregnancy.
In theory, telemedicine would make it possible for these women to have access to the full range of family planning resources. After a woman calls a toll-free number, the Tabbot Foundation arranges an ultrasound and a blood test for them at a local clinic. A medical professional connected with the Tabbot Foundation then receives the results and, if the patient is approved, consults with the patient by phone about what they are about to experience. The service costs $250.
The patient is then mailed mifepristone and misoprostol—the drugs used in combination to induce abortion—prophylactic antibiotics, painkillers, and anti-nausea drugs. Women can expect a nurse to call one day later to check in, and are given a blood test 10 days later to confirm whether the termination has been successful. Though the abortion pill is recommended for women up to 10 weeks into their pregnancy, the Tabbot Foundation's service is only offered to women who are less than 63 days pregnant.
The study revealed that, out of 1000 women who received the abortion pill though this method, 717 women reported they took the abortion drugs provided by the foundation, according to the Sydney Morning Herald. The study found that 82 percent of women had a confirmed normal termination; fifteen percent were not able to be contacted.
It is a low-risk procedure. Very few women needed extra support at a hospital for assistance with bleeding or additional pain relief.
"Two women (0.3 percent) still had viable pregnancies after taking the drugs," the study reported, according to the publication. In addition, "two percent of pregnancies were terminated, but a small amount of tissue remained in the uterus" and only "0.6 percent of pregnancies were non-viable, but were not expelled from the body."
In these cases, women had the option of taking another dose of misoprostol, undergoing a dilation and curettage procedure, or waiting for the tissue to expel on its own.
The study also found that women in rural areas who lack access to services may still face barriers to accessing the telemedicine procedure. Over 40 percent of patients in the review were from major cities. Thirteen percent were from "outer regional areas," the Sydney Morning Herald reports, and just over eight percent were from remote or very remote areas. The cost of the procedure and lack of awareness could play a factor; Australia's universal healthcare system does not cover the cost of telemedicine abortion.
"Essentially, the current system is discriminatory against women… and it doesn't make sense economically," Belton, the study's author, told the publication.
However, for women who are able to have full access to abortion via telemedicine, the procedure is convenient and simple. "Telehealth abortions with tablets are a safe and effective way for Australian women to seek a termination of pregnancy," Belton said in a press release. "It is a low-risk procedure. Very few women needed extra support at a hospital for assistance with bleeding or additional pain relief."
This study could prove instructive for the state of abortion access in the US, where it's currently impossible to access the abortion pill by mail due to strict regulations that were enacted under the guise of keeping women safe.
When the abortion pill was approved for use in the US, the FDA mandated that it fall under a set of added regulations known as a Risk Evaluation and Mitigation Strategy (REMS), which are typically only required for drugs that cause severe adverse effects. Under those rules, the drug can only be dispensed in clinics or medical offices.
That means telemedicine for abortion looks a lot different here, if it exists at all. In 2008, Iowa pioneered a telemedicine method to circumvent the restrictions that still requires a patient to visit a designated clinic in their area. The patient's doctor will be in a different city, appearing on a video monitor, to remotely open a drawer in the patient's exam room that contains the medication and watch them take them ingest it.
And even then, anti-abortion politicians in the state tried to shut down the telemedicine program in 2013, claiming that "the drugs could cause complications and that dispensing them from a remote location was unsafe," according to the New York Times.
The ban was ruled unconstitutional in 2015, but bans on telemedicine abortion have nonetheless prevented the method from gaining ground—and kept women from a revolutionary method of accessing care. The Guttmacher Institute reports that "19 states require that the clinician providing a medication abortion be physically present during the procedure, thereby prohibiting the use of telemedicine to prescribe medication for abortion remotely." Earlier today, the state of West Virginia took the first step to explicitly ban telemedicine abortion.
However, studies have proved time and time again that the abortion pill is safe. "We now have huge amounts of clinical data [on mifepristone], and there's nothing exceptionally dangerous about it," Beverly Winikoff, the author of a study calling for the removal of the REMS protocols, previously told Broadly. "Many other drugs have far greater risks."
Elisa Wells, the co-director of the Plan C campaign, which promotes information about the abortion pill, believes that one day access to the abortion pill will be broadened even beyond the Tabbot Foundation's model.
"The Tabbot Foundation research demonstrates that a less medicalized model for providing abortion pills is safe and effective. But the model still has barriers to access that are likely not necessary," she told Broadly in an email, citing the required doctor's visit for an ultrasound and blood test. "It's time to reimagine abortion pills as a method women can use themselves independently of the medical system. We believe that research to test direct access to and self-use of abortion pills will ultimately show that this is a method that women can very safely and effectively use on their own."