The research
The study, led by researchers at the University of California, San Francisco, looked at the experience of more than 6,000 patients in the months after the federal government began allowing abortion pills to be mailed, from April 2021 to January 2022.
Patients used one of three telemedicine abortion agencies—Hey Jane, Abortion on Demand, or Choix—serving 20 states and Washington, DC. sparking a wave of state abortion bans and restrictions. Since then, more telemedicine services have opened and are used by many patients who find the method more convenient, private and affordable than visiting clinics or doctors, especially if they have to travel to another state.
The study services prescribed pills to patients who were 10 weeks pregnant or less (one service had an eight-week limit) and screened patients for medical issues that would make them ineligible, such as ectopic pregnancies or blood clotting disorders.
In most cases, physicians, nurses, physician assistants, and midwives on the services were able to determine eligibility from written or verbal information patients provided about their pregnancy and health, without requiring them to perform ultrasounds, which it is logistically difficult for some patients. . If medical eligibility was unclear, patients were asked to have ultrasounds — 486 did and then were prescribed pills, making up about 8 percent of the 6,034 patients who received pills in the study.
Results
The researchers reviewed the services’ medical records and were able to determine abortion outcomes for three-quarters, or 4,454, of the patients. The vast majority — 4,351 patients, or 97.7 percent — completed abortions with the standard regimen: mifepristone, which stops a pregnancy from developing, followed a day or two later by misoprostol, which induces contractions to expel the tissue.
Of the remaining patients, 85 required additional measures to complete the abortion, usually with additional medication or an aspiration procedure in a medical facility.
Eighty-one patients visited emergency departments and 15 patients had serious complications. Ten patients were hospitalized. Six received blood transfusions, two were treated for infections, and one underwent surgery for an ectopic pregnancy.
Six patients were found to have an ectopic pregnancy, which would have made them ineligible for the pills. Studies show that ectopic pregnancy cannot always be detected early, even with ultrasound.
Of the patients who visited emergency departments, 38 percent ended up not needing treatment. Patients sometimes visit emergency departments because “they don’t know if what they’re experiencing is normal, and sometimes they don’t have anyone to ask and they don’t want to tell a lot of people about their abortion,” said Dr. Ushma Upadhyay, a public health scientist at UCSF and one of the study’s authors.
No patient was found to be more than 10 weeks’ gestation.
Efficacy and safety rates were similar to those in several large studies of medication abortion and telemedicine abortion where ultrasound was required. It was also similar to the FDA label rates for mifepristone.
The researchers also found no difference in safety or effectiveness for patients who received real-time video consultations compared with those who received prescriptions based on written information provided via text message, as most patients did.
Two patients asked about “reversal abortion pills,” an unscientific theory that miscarriages can be stopped after taking the first drug. Both were told “there is no evidence-based reversal treatment” and referred to urgent personal care, the study said.
Greater impact
The medication abortion is being challenged in a lawsuit filed against the FDA by abortion opponents seeking to limit mifepristone. One of the plaintiffs’ claims is that the abortion pills are dangerous. The FDA cited overwhelming scientific evidence that the pills are safe, and two studies cited by abortion opponents to support their claims were recently retracted by a journal editor.
In August, an appeals court said mifepristone could remain legal but ordered significant restrictions that would prevent it from being shipped or prescribed via telemedicine. The Supreme Court will hear arguments in the case next month. The results of the new study may be cited by those urging the court to keep telemedicine abortion available.
