A large study about telehealth abortion conducted in the US has concluded that it is “effective, safe and comparable to published rates of in-person medication abortion care.”
The results, published in Nature, come at a significant point in the debate around abortion, which continues to rage in the US. Since the Supreme Court’s decision in 2022 to overturn Roe v. Wade, 21 states have banned or restricted abortions, 14 of which have implemented full bans.
The role of telehealth in providing equitable abortion access
The bans have resulted in surging demand in states where abortion is legal, particularly in states bordering on those with complete bans.
According to the Guttmacher Institute, New Mexico – which borders Texas and Oklahoma (both of which have complete bans) – has seen the percentage of abortions obtained by patients travelling from outside of the state increase drastically, from 38% in 2020 to 72% in the period between January and June 2023.
The trend has also been evident in Kansas – which borders Oklahoma and Missouri (both of which have complete bans) – where 66% of abortions were obtained by patients from outside of the state between January and June 2023, up from 52% in 2020.
Similarly, Illinois – bordering Indiana, Missouri and Kentucky (all with complete bans) – has seen a significant increase, with the percentage jumping from 21% in 2020, to 42% between January and June 2023.
The study considered that this demand for out-of-state care necessitated a better comprehension of the safety of telemedicine abortion: “Telehealth became vital to meeting increased demand by reducing appointment waiting times and serving patients from states with abortion bans.”
However, the researchers also noted that mifepristone (the abortion drug used in the study) was “under threat” after the federal court ruled to reverse the US Food and Drug Administration’s regulatory approvals of the drug. The Biden administration is appealing the decision, which would prevent telemedicine prescriptions and postal delivery of the drug.
GlobalData analyst Wafaa Hassan said of the role of telehealth in providing equitable abortion access: “It can improve access to reproductive healthcare services, especially for individuals in remote or underserved areas where access to abortion clinics may be limited. Another advantage can be more convenient for patients, allowing them to have consultations from the comfort of their homes, which might be particularly important for those facing logistical challenges or stigma.”
The Nature study
The California Home Abortion by Telehealth (CHAT) prospective study was conducted at the University of California; it used data on 6,034 abortions recorded at three virtual clinics operating in 20 states and Washington DC between April 2021 and January 2022. It defined effectiveness as “complete abortion after 200mg mifepristone and 1,600μg misoprostol (or lower) without additional intervention” and measured safety “by the absence of serious adverse events.”
It found that 97.7% of abortions were completed successfully after the initial treatment, and “effectiveness also did not differ according to patient age, pregnancy duration, race, ethnicity or ethnic grouping, urbanicity, previous birth, previous abortion or whether the patient had screening ultrasonography.”
Researchers also noted that the effectiveness of synchronous (video call) and asynchronous (secure messaging) methods was “similar”, with the former being 98.3% effective, and the latter 97.4%. Of the sample, 72.3% of patients received asynchronous care.
Discussing the results, the researchers wrote: “These findings provide evidence that telehealth for abortion is effective and safe, with rates similar to in-person care. Additionally, synchronous and asynchronous care are comparably effective and safe. Although telehealth models cannot serve the needs and preferences of everyone, such as those who do not have electronic devices or those who are beyond the first trimester of pregnancy, offering people telehealth options has the potential to expand access to abortion care.”
They concluded by calling for a reconsideration of equitable healthcare: “This study demonstrates that policies that restrict telehealth abortion owing to concerns or claims about effectiveness or safety need to be revisited and revised to ensure equitable access to this essential healthcare service.”
