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Eliminating routine screenings in medication abortion care proved safe and effective, offering a path to reduce delays and expand reproductive autonomy. 

A study published in the June 2025 issue of American Journal of Obstetrics & Gynecology examined changes in clinician practices during COVID-19, revealing that despite strong evidence supporting streamlined “no-test” medication abortion to improve access, in-person protocols remain prevalent.  

Researchers assessed the safety and effectiveness of medication abortion with and without in-person screening methods such as ultrasonography or pelvic examination.  

They analyzed medication abortions from February 2020 to January 2021 across 3 United States (U.S) clinics, including all patients with gestational age under 77 days in the “no-test” group (no screening ultrasonography or pelvic examination) and a random sample from the “screening test” group (received either test). Both groups received care in person or via telehealth. The missing data was handled using imputation and applied inverse-probability-of-treatment-weighted logistic regression to compare complete abortion without further treatment (effectiveness), absence of major adverse events (safety), emergency department visits, and unintended abortions beyond 77 days of gestation (a commonly used limit for medication abortion).  

The results showed that 1,727 abortions were performed without screening tests and 649 with such tests. Patients in the no-test group had a shorter average gestational age (48 vs 50 days, P<0.001), were more likely to be White (43% vs 32%, P<0.001), less likely to live in urban areas (78% vs 83%, P=0.004), more often received medications by mail (35% vs 1%, P<0.001), and more frequently paid out-of-pocket (62% vs 55%, P=0.002). Outcome data were available for 58% of the no-test group and 72% of the screening test group (P<0.001). After imputing missing data, effectiveness was 93.4% in the no-test group and 95.3% in the screening group (Risk Difference [RD]: -1.9% [95% CI: -6.9%, 3.1%]); safety was 98.7% vs 99.8% respectively (RD: -1.1% [95% CI: -2.9%, 0.7%]). Complete case analysis showed similar findings: effectiveness 94.1% vs 95.8% (RD: -1.7% [95% CI: -4.4%, 1.1%]); safety 99.2% vs 100% (RD: -0.81% [95% CI: -1.74%, 0.11%]). Abortions beyond 77 days occurred in 0.59% of cases across both groups and 4.0% involved emergency department visits. Emergency visits requiring treatment were higher in the no-test group (2.1% vs 0.39%); RD: 1.7% [95% CI: 0.1%, 3.3%]).  

Investigators concluded that medication abortion without screening ultrasonography or pelvic examination was as safe and effective as care with these tests, supporting its routine use for eligible patients. 

Source: ajog.org/article/S0002-9378(25)00387-4/abstract