Note: This originally published in Rewire News.
A new study on the safety of telemedicine abortion further upends anti-choice legislators’ excuses for restricting at-home medication abortions and paves the way to vastly expand options for people seeking this service.
Published in The BMJ by a collective of international professors and the founder of Women on Web (WoW), an online telemedicine service based out of the Netherlands, the study examined 1,000 women living in the Republic of Ireland and Northern Ireland who had an abortion with medication from WoW between January 2010 and December 2012. All of the women reported being less than 10 weeks pregnant, per WoW’s guidelines.
The results are overwhelmingly positive: 95 percent of the self-managed abortions were successful with extremely low rates of adverse events. Less than 1 percent of the women reported needing a blood transfusion post-abortion, and only 2.6 percent said they received antibiotics. Zero deaths were reported. And virtually all of the patients reported being able to cope with their decision to have an abortion.
“Self sourced medical abortion using online telemedicine can be highly effective, and outcomes compare favourably with in clinic protocols,” the researchers noted. “Women are able to self identify the symptoms of potentially serious complications, and most report seeking medical attention when advised. Results have important implications for women worldwide living in areas where access to abortion is restricted.”
The study reinforces previous research on telemedicine abortion. A survey of Alaskan abortion providers, published in 2016, found that the service gives patients—including those in rural areas with limited access—greater choices in abortion care, and that it is as safe and effective as in-clinic medical abortions.
Although the WoW study focused on populations outside of the United States—who had to procure the abortion pill online, since abortion is not available in formal health-care settings throughout Ireland—the findings certainly translate across the Atlantic, where access to abortion is rapidly dwindling.
Pregnant people in the United States who seek abortion care are facing mounting obstacles, which are unlikely to slacken under an anti-choice administration and GOP-controlled Congress. During the first three months of 2017, legislators introduced 431 measures to restrict abortion, including 88 measures that would ban abortions completely or under certain circumstances in 28 states, according to the Guttmacher Institute.
Such legislative attempts, combined with GOP family planning budget cuts, have very tangible impacts. This month alone, Planned Parenthood affiliates announced the closures of ten health centers across the Midwest and Southwest, including the only clinic in Wyoming, leaving vulnerable rural populations with little-to-no reproductive health-care access. And while anti-choice advocates claim that other health centers could absorb Planned Parenthood’s patients, it’s just not true.
Telemedicine could very well be the antidote to social conservatives’ attacks against reproductive rights—but only if states ease restrictions on who is allowed to perform medication abortion, and how.
While clinic shutterings and attempts to curtail surgical abortions dominate public awareness, state-level restrictions on medical abortion are likewise numerous. The majority of states (37) require clinicians who provide medication abortion to be licensed physicians, and 19 states require that the clinician be physically present during the administration of the medication, thereby eliminating the possibility of telemedicine.
“These restrictions are unnecessary,” Leah Torres, a Salt Lake City, Utah-based OB-GYN and abortion provider, told Rewire. “Legislators do not provide abortion care, they do not understand the guidelines involved so instead they invent their own.”
Indeed, such restrictions are imposed under the pretext of protecting the physical safety of women, but fly in the face of medical evidence. According to the American College of Obstetrics and Gynecology (ACOG), “advanced practice clinicians, such as nurse-midwives, physician assistants, and nurse practitioners, possess the clinical and counseling skills necessary to provide first-trimester medical abortion.” What’s more, ACOG notes that “[m]edical abortion can be provided safely and effectively via telemedicine with a high level of patient satisfaction,” and that it is “equally effective when compared with an in-person visit with a physician.”
Telemedicine is becoming increasingly popular among the broader medical community. The American Hospital Association contends that telemedicine “is vital to our health care delivery system, enabling health care providers to connect with patients and consulting practitioners across vast distances,” and the American Medical Association agrees, hailing telemedicine as “another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions.”
The evidence is clear: Telemedicine can be an asset to patients. Moreover, it can also prove particularly advantageous to select populations, especially when it comes to abortion. “Every woman would benefit from increased options of how and where to obtain abortion care, including via telehealth networks,” Leslie McGorman, NARAL Pro-Choice America deputy policy director, told Rewire. “Women in rural and medically underserved communities would especially benefit from an increased access to healthcare through a telehealth system.”
The benefits of telemedicine abortion are numerous, including expanded access to early abortion care (first-trimester abortions are the most common), a reduction in second-trimester abortions, and an overwhelming convenience factor. Patients can avoid long-distance travel, reduce associated expenses (like child care, gas and mileage, and potential loss of pay from taking time off work), and undergo the procedure in a private setting. It also helps patients evade harassment and intimidation by anti-abortion protesters outside of clinics.
And yet, U.S. legislators continue to deny women access to at-home medication abortion, not because of medical evidence, but in spite of it. As recently as January, a Utah lawmaker defending an anti-abortion provision in a bill expanding telemedicine services said that the proposed restriction (limiting telemedicine abortion to cases of rape, incest, or life endangerment only) was “for safety and health.” Specifically, Rep. Ken Ivory (R-UT) said, “An abortion being something that terminates a life, to do that without ever seeing the patient, without having contact with the patient — as a matter of state policy, we’re putting in code that we don’t believe that’s appropriate,” according to Deseret News.
The WoW study findings—which clearly delineate the safety of telemedicine abortion—help expose legislators’ condescending, paternalistic justifications. Restricting medical abortion access isn’t about protecting women’s health and safety, it’s about furthering a political agenda on the backs—or more accurately, the wombs—of women.
“With the approval of medication abortion came a choice for women. Some women choose to have a quick surgical procedure in a clinical setting, while others choose to have a medication abortion in … a clinical setting that is not a stand-alone abortion clinic,” explained McGorman. “Yet some fringe groups have aggressively pushed restrictions on medication abortion because it increases access to health care and simultaneously makes it harder for anti-choice groups to intimidate doctors and patients … and anti-choice politicians and organizations have had a lot of success targeting stand-alone abortion clinics. ”
In other words, medication abortion at home simply affords women too much freedom while threatening to erode the success of anti-abortion activists and lawmakers.
“Withholding access to abortion care is no different than withholding access to any other kind of health care,” said Torres. “No one is regulating chemotherapy for cancer or stents versus gallons in cardiothoracic surgery. Why not? Because no oncologist or surgeon would stand for legislative interference that puts their patients’ lives in danger. Why do we as a society stand for endangering the lives of pregnant people?”
In light of draconian abortion policies proliferating in the United States, the study’s authors predict that “the visibility and importance of self sourced medical abortion will continue to increase.” And they’re right; recent reports of women turning to another Netherlands-based website for guidance on self-managed medical abortions underscore the need and desire for expanded options.
If the WoW study teaches us anything, it’s that safe medical abortion can take place outside of (misguided) legal parameters. Our legislators must listen to medical experts and the people who have abortions in order to safeguard women’s health and safety. Because so long as there are unwanted pregnancies, pregnant people will continue seeking abortion care wherever—and however—possible. We need to ensure our options are safe and grounded in science, not political self-interest.