(The Conversation) – For many people, access to abortion care can be a major challenge. Abortion services are usually only available at select clinics with specialized equipment like ultrasound, often requiring long distances to get there. When medical abortion, or abortion with pills, was introduced in the United States in 2000, it offered a more accessible option for terminating pregnancy.
However, medical abortion was initially highly regulated and could only be performed in person at abortion clinics. The guidelines also required an ultrasound to confirm that the patient was less than 11 weeks pregnant and not ectopic, which means having a pregnancy where the fertilized egg implants outside the uterus and can lead to life-threatening miscarriage.
Due to the pandemic, however, a new screening model has emerged that relies solely on a patient’s medical history to confirm eligibility for medical abortion. This means that patients do not need to undergo an in-person pelvic exam or ultrasound. They can even have their medications shipped after a teleconsultation with a clinician. The United States Food and Drug Administration has also permanently authorized mail-order pharmacies to ship abortion drugs to patients.
As a public health social scientist who has studied abortion safety and access for more than a decade, I wanted to see how this new model of care compared to its predecessor. In our new study, my colleagues and I found that screening a patient for eligibility based on their medical history instead of a physical exam or ultrasound was just as safe and effective as testing and in-person exams.
In December 2021, the FDA finally ruled that medical abortion could be received by mail after a remote telehealth consultation.
Data on remote teleconsultations
To compare the safety and effectiveness of these two models of care, my colleagues and I collected data from the medical records of nearly 3,800 patients from 14 clinics across the United States. About 66% of patients saw a clinician in person and picked up their medications at the clinic. , while 34% had a remote telehealth visit and received their medications by mail. None of the patients in either group received a screening physical examination or ultrasound.
We looked at the data for any adverse events or problems the patients might have had after taking the abortion pills. Overall, we found that 95% of patients completed their abortion without further intervention. This is comparable to completion rates from previous studies of medical abortion prescribed after ultrasounds and in-person examinations. Only 0.5% of patients experienced a serious adverse event, also comparable to rates previously reported after in-person examinations.
We also found no significant difference in effectiveness or safety between the group who collected their abortion pills in person and those who received them by mail after a telehealth consultation.
Overall, we found that medical abortions performed after reviewing a patient’s medical history are just as safe and effective as those ordered after an in-person pelvic exam and ultrasound.
Expand access to equitable care
With a limited number of clinics and providers, insurance coverage bans, and state-imposed restrictions, people seeking abortions face significant barriers to getting the care they need.
These barriers disproportionately affect people of color, low-income groups, and other marginalized people.
If Roe v. Wade is canceled or significantly altered, nearly half of the country will face even more difficulty accessing abortion care.
However, minimizing in-person testing by moving to remote testing could expand access to abortion care to more patients. Because no special equipment like ultrasound machines are needed, more clinicians can write a prescription for the pills. Primary care providers working in rural, low-income, and other marginalized communities could screen for medical abortion and increase equitable access to abortion care.
The American College of Obstetricians and Gynecologists and the National Abortion Federation have already updated their guidelines to reflect that reviewing medical history without an in-person pelvic exam and ultrasound is sufficient to confirm eligibility for medical abortion. .
But it’s important to note that state restrictions prevent the implementation of this new model of care nationwide. Some states legally require ultrasounds, and others require an in-person visit or prohibit telehealth screenings. As the high rates of safety and effectiveness in our study and other studies show, these laws are not based on scientific evidence and medical necessity as they claim.
Although this new model was originally introduced to reduce physical contact during the pandemic, it could help break down barriers to medical abortion and expand access to equitable care for all patients.