By Manas Mishra

(Reuters Health) – Terminating a pregnancy with medication under virtual supervision from a clinician is just as effective and safe as doing so at a medical facility, a study across four U.S states suggests.

The findings mean that telemedicine could give more U.S. patients access to safe and legal abortion, especially in states passing legislation to impose severe restrictions on a woman’s ability to terminate her pregnancy, the researchers said.

“Telemedicine can improve health equity by ensuring that more people have access to the care they need – including abortion – in a timely manner,” said study leader Julia Kohn, national director of research, evaluation and data analytics at the Planned Parenthood Federation of America.

“As access to abortion shrinks across the country, telemedicine is one strategy for expanding patients’ access to safe, legal abortion, including for those living in remote or rural areas,” Kohn told Reuters Health by email.

Access to abortion, which includes medication abortion and surgical procedures, has shrunk in the U.S., with 90% of all counties lacking an abortion provider as of 2014, the study team notes in Obstetrics & Gynecology. In addition, 27 U.S. cities with populations over 100,000 have no abortion provider within 100 miles.

In a medication abortion, two drugs that come in pill form, mifepristone and misoprostol, are given to terminate early pregnancy.

Mifepristone, which is taken a couple of days before misoprostol, is only available in hospitals and clinics under the supervision of a certified provider, under U.S. Food and Drug Administration regulations.

Traditionally, patients seeking a medication abortion at Planned Parenthood, the largest single provider of abortions in the U.S., visit a health center and receive in-person care from staff. After giving consent, they meet with their abortion provider, who is usually a clinician, such as a doctor or nurse practitioner, and take the mifepristone dose in the clinician’s presence. Sometimes, when a clinician is not available on-site, patients at the health center meet with the doctor or nurse through a video-conferencing platform and take the mifepristone in view of the clinician.

For the study, researchers looked at data from 26 Planned Parenthood centers across Alaska, Idaho, Nevada and Washington on medication abortions provided from April 2017 to March 2018.

Of more than 5,900 patients who underwent medication abortion, 738 women “met” with providers who were not physically at the clinic.

Among the patients who took the first pill after an in-person meeting with a clinician, 77% followed up with the clinic within 45 days to report the results, while 60.3% of telemedicine patients followed up.

Of the women who followed up, 73 had ongoing pregnancies. This included 0.5% of the telemedicine group and 1.8% of the in-person group. Among 188 women who required an aspiration abortion – either for ongoing pregnancy or incomplete abortions – just six were telemedicine patients.

The study team also looked at serious side effects or safety issues, like heavy bleeding, and found 17 that were related to the abortions; one of these occurred in a telemedicine patient. This rate of adverse events is low and aligns with published literature, the researchers note.

It’s unclear why rates of ongoing pregnancy and aspiration abortions were higher in the women who met with clinicians in person, but it’s possible the difference is due to the lower rate of follow-up reporting from the telemedicine group, the authors note. The fact that about one quarter of all patients did not follow up is one limitation of the study, they point out.

Still, the study team writes, the results show across diverse states that telemedicine supervision of women when they take mifepristone can be as safe and effective as the standard procedure of administering the medication face-to-face with a clinician in a medical setting.

“To the extent that state bans on telemedicine for abortion rest on arguments of improved patient safety, the findings of this and previous studies do not support such contentions,” the study team concludes.

SOURCE: Obstetrics & Gynecology, August, 2019.