This article was originally included on The conversation.
For many people, access to abortion care can be a major challenge. Abortion services are usually only available in certain clinics with specialized equipment such as ultrasound, which often requires long-distance travel to get there. When medical abortionor abortion with pills, was introduced in the United States in 2000, it offered a more affordable option to terminate a pregnancy.
Initially, however, medical abortion was highly regulated and can only be dispensed in person at abortion clinics. The guidelines also require ultrasound to confirm that the patient has been pregnant for less than 11 weeks, and not ectopicwhich means pregnancy in which the fertilized egg is implanted outside the uterus and can lead to life-threatening miscarriage.
Due to the pandemic, however, a new screening model appeared to rely solely on the patient’s medical history to confirm their eligibility for medical abortion. This means that patients should not undergo a personal pelvic examination or ultrasound. They can even get their medication in the mail after a remote telehealth consultation with a clinician. The US Food and Drug Administration too permanently authorized pharmacies for mail orders to deliver abortion drugs to patients.
Like sociologist of public health who has been studying safety and access to abortion for more than a decade, I wanted to see how this new model of care compared to its predecessor. In our new studyMy colleagues and I have found that screening for a patient’s eligibility based on medical history instead of a physical examination or ultrasound is just as safe and effective as personal tests and exams.
Data for remote telehealth consultations
To compare the safety and effectiveness of these two models of care, my colleagues and I collected medical records from nearly 3,800 patients from 14 clinics in the United States. About 66% of patients visited a clinician in person and took their medication at the clinic, while 34 % had a remote telehealth visit and received their medication in the mail. Neither patient in either group received a screening physical examination or ultrasound.
We reviewed data on any adverse events or problems that patients may have had after taking the abortion pill. Overall, we found that 95% of patients completed their abortions without further intervention. This is comparable to the completion rate of previous studies On medical abortion prescribed after personal ultrasound and examinations. Only 0.5% of patients had a serious adverse event, also comparable to previously reported rates after personal exams.
We also found no significant difference in efficacy or safety between the group that took their abortion pills in person and those who received them in the mail after a teleconsultation consultation.
In general, we found that medical abortions granted after a review of the patient’s medical history were just as safe and effective as those prescribed after a personal pelvic examination and ultrasound.
Expanding access to equitable care
S limited number of clinics and providers, bans on insurance coverage and state restrictions, people seeking an abortion face significant barriers to obtaining the care they need. These barriers disproportionately affect colored people, low-income groups and other marginalized people.
However, minimizing personal tests by switching to remote screening can expand access to abortion care for more patients. Because no special equipment such as ultrasound machines is needed, more clinicians can prescribe the pill. Primary care providers working in rural, low-income and other marginalized communities could screen for medical abortion and increase equitable access to abortion care.
IN American College of Obstetricians and Gynecologists and on National Federation of Abortion have already updated their guidelines to reflect the fact that a medical history examination without a personal pelvic examination and ultrasound is sufficient to confirm the admissibility of abortion with medication.
But it is important to note that state restrictions hinder the implementation of this new model of care throughout the country. Some countries legally requires ultrasound, and other countries either require a personal visit or prohibit telehealth screenings. Because of the high levels of safety and effectiveness of our study and others someone’s show that 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 a pandemic, it can help remove barriers to medical abortion and expand access to fair care for all patients.