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Telemedicine abortion – a patient-friendly pathway that could help expand safe abortion access globally

Blog 28 May 2021

May 28The last year has been difficult and challenging for health care professionals everywhere, Miss Ranee Thakar, Senior Vice President for Global Health at the RCOG, writes.

We have been at the forefront of fighting the COVID-19 pandemic, while manoeuvring through the challenges of providing essential obstetric and gynaecological (O&G) care. In the UK and abroad, we have seen procedures postponed and waiting lists increase. However, within O&G services, one medical pathway has instead seen a significant improvement to patient care during this time.

The establishment of telemedicine for abortion in Great Britain has provided those seeking a medical abortion in the first 10 weeks of pregnancy the option of accessing care without needing to leave their own homes. This was made possible by the introduction of emergency legislation that permits home use of mifepristone, one of the two drugs used to induce an abortion. Misoprostol, the second drug required, was authorised for home use in 2018.

Telemedicine is providing an additional pathway for people to access the care they need. While it isn’t a one-size fits all solution, a recent study found that it is preferred by many. The evidence from the UK on the effectiveness, safety and positive patient experience is incredibly compelling. Abortions take place earlier in the pregnancy, increasing safety and reducing the risk of complications, and the vast majority of women report feeling safer and more comfortable undergoing the procedure in the comfort of their own home. It is of course important that choice is maintained, and anyone who prefers a face-to-face consultation is offered one.

It is well known that the Royal College of Obstetricians and Gynaecologists has been an advocate for the use of telemedicine to aid safe abortion access, a position that became more urgent because of the pandemic, and we are keen to see the practice become a permanent feature of abortion care in the United Kingdom.

FIGO, the International Federation of Gynecology and Obstetrics, in April issued its own endorsement in favour of the permanent adoption of telemedicine abortion services globally, recognising that technological adaptation in response to the COVID-19 pandemic has demonstrated the potential for telemedicine for abortion to improve the provision of safe abortion care in currently underserved communities.

The potential of telemedicine for abortion in settings where safe abortion access is limited is enormous, but not new. Many women, girls and pregnant people across the world are accessing abortion care services online or over the phone already, yet in most instances, these women are accessing the service outside of the regulated framework.

The WHO guidelines on safe abortion stipulate that self-management of abortion during the first trimester using mifepristone and misoprostol in combination, or when mifepristone is not available using misoprostol only, is safe.  The guidelines make clear that for a self-management regime to be successful and safe, the information provision for people about self-managing abortion must be clear and comprehensive, and counselling should be available on request. Health care providers and health systems more broadly must be supportive, equipped, and willing to care for individuals self-managing their abortion if needed or requested. Quality assured medication must be available in the right dosage and with sufficient stocks.  Finally, the legislative and policy framework in a country needs to be adjusted to allow for self-managed abortion.

Unsafe abortions are among the leading causes of maternal mortality and morbidity worldwide. The risk of dying from an unsafe abortion is highest for people in Africa, where nearly half of all abortions happen in potentially dangerous circumstances. Almost every injury and death from unsafe abortion is preventable with the use of effective contraception, provision of safe abortion, and timely post-abortion care. The legal status of abortion does not affect the number of women and girls seeking one, but the prevalence of unsafe abortion is greatest in countries with restrictive abortion laws.

The experiences from abortion care providers in the UK also indicate that the service is making access to abortions safer for those with safeguarding issues. Since the introduction of telemedicine, MSI UK has reported an increase in safeguarding disclosures, including from survivors of domestic or sexual violence. While some patients continue to favour in-clinic appointments, many seem to feel more able to speak freely about intimate or upsetting details over the phone.

While telemedicine can never fully replace in-clinic abortion services, it is providing an additional, safe, patient-friendly pathway, that can help to reduce stigma and increase access.

The UK is not the only country where telemedicine for abortion has been formally introduced. Other countries include South Africa, the USA, Kenya and Australia. We are learning and sharing these experiences to help colleagues and governments around the world find out how they can implement the telemedicine pathway to safe abortion and help prevent unnecessary loss of life due to unsafe abortion. While COVID-19 has caused unprecedented disruption globally, the new innovative practices discovered due to its presence must be embraced.

 

Notes:

  • Today, 28 May, marks the International Day of Action for Women’s Health.
  • The RCOG is committed to promoting access to sexual and reproductive health and rights, including access to safe abortion, globally. Through the Making Abortion Safe programme, RCOG is working with Sexual and Reproductive Health and Rights (SRHR) Champions from Nigeria, Rwanda, Sierra Leone, Sudan and Zimbabwe, to address the barriers to safe abortion and post-abortion care.
  • Sign up here for updates from the Making Abortion Safe programme.
  • The RCOG and FSRH’s key messages on safe abortion are available here.
  • To contact the RCOG press office call +44 (0)7986 183167 or email pressoffice@rcog.org.uk.