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New study finds telemedicine for abortion care is safe and more accessible

News 19 February 2021

A new study analysing the latest national data on early medical abortions from before and after the coronavirus pandemic has found that allowing women to have abortions at home has provided a safe, effective and more accessible service.

 At the start of the coronavirus pandemic, the Royal College of Obstetricians and Gynaecologists (RCOG) urged the Government to change the law so that women could access early medical abortions at home. This was approved in England in March 2020 and shortly after in Scotland and Wales.

The largest ever study of UK abortion care, carried out by researchers at the University of Texas at Austin, the British Pregnancy Advisory Service, MSI Reproductive Choices and National Unplanned Pregnancy Advisory Service, has analysed the outcomes of more than 50,000 early medical abortions that took place in England, Scotland and Wales between January and June 2020, both before the telemedicine service was introduced and after. The aim was to compare data and see how the telemedicine service compares to the service before.

Prior to the telemedicine service being approved, anyone seeking an abortion needed to attend an in-person appointment to receive an ultrasound scan and take the medication used to bring about an abortion within the clinic. Under the new guidelines, consultations were encouraged to take place by telephone or video call, and medication could be taken at home, with an ultrasound scan only being required if needed.

The key findings from the study are:

  • Waiting times from when the woman has her consultation to treatment improved from 10.7 days to 6.5 days
  • Women are able to receive care much earlier in their pregnancy – with duration of the pregnancy at the time of the abortion significantly reduced.
  • The effectiveness of the treatment remained the same for abortions carried out through the traditional service and the telemedicine service.
  • There were no cases of significant infection requiring hospital admission or major surgery. Contrary to misleading claims, no person died from having an early medical abortion at home.
  • 80 per cent of women said telemedicine was their preferred option and they would choose it in the future.
  • None of the women said they weren’t able to consult in private using teleconsultation.

The UK government's consultation on whether or not to make the telemedicine abortion service permanent will close on 26th February 2021. The RCOG, along with abortion service providers in the UK, is urging the UK government to make the telemedicine service permanently available to women.

Lead author Dr Abigail Aiken, Associate Professor of Public Affairs at The University of Texas at Austin, said: “The evidence strongly supports adoption of this patient-centred model as standard of care for early medical abortion.  

“We found that 98.8% of women were able to end their pregnancies without any further intervention and less than 0.05% experienced a serious complication. The outcomes for the traditional in-person model were almost exactly the same. Most patients prefer the telemedicine model because it allows them to access services earlier and without unnecessary barriers. 

“Good public policy is based on robust evidence and on the experiences of those it affects. Our study provides clear direction to policymakers on both these things.”

 Professor Dame Lesley Regan, Chair of the RCOG’s abortion taskforce, said: 

“This study proves there is no medical reason not to make the current telemedicine service permanent. 

“One argument I hear time and again is that changing abortion laws makes it ‘easier’ to get an abortion and will lead to more women choosing to have one. Indeed, some may believe that keeping abortion difficult to access, more unpleasant to undergo and more dangerous, will persuade women to continue their unwanted pregnancy. 

“You just have to look around the world to recognise this claim is invalid. Everyday scores of desperate pregnant women put themselves in extreme danger by undergoing illegal and unsafe abortion. Reducing access to abortion doesn’t make it any less common, but it does make it less safe.”

Dr Patricia Lohr, Medical Director at bpas, said:

“This study contributes yet more compelling evidence that telemedicine is a safe, effective, and patient-centred way of providing early medical abortion. Telemedical abortion care has protected women’s health and wellbeing during the pandemic, and women have told us how much they value the service and want it to continue so other women in the future can benefit. While other healthcare services have been suspended or seen significant increases in waiting times during the pandemic, access to abortion has not only been maintained but has improved, enabling women to end pregnancies at the earliest possible gestations. 

“At a time when the NHS is under severe strain, the ability to provide a better service that women prefer at a lower cost is rare. It would make no sense for the government to remove a service model that has clear benefits to the health and wellbeing of patients. The government are now in a position to secure a world-leading reproductive healthcare framework, and we urge the Secretary of State to do so by making telemedical abortion care a permanent option.”

Dr Jonathan Lord, Medical Director for MSI Reproductive Choices UK, said: 

“The largest-ever study of UK abortion care proves without a doubt that early medical abortion at home using telemedicine is as safe and effective as traditional methods, and highly valued by the 52,000 women who participated in the research. 

"Since its introduction, waiting times and gestations have significantly decreased, with 40% of abortions now provided at less than six weeks. Being able to access abortion care earlier in pregnancy has also reduced the low complication rate even further. 

“At MSI UK, we have also seen a major uplift in safeguarding disclosures, including from survivors of domestic and sexual violence. Crucially, telemedicine has provided a lifeline for vulnerable women and girls who cannot attend consultations in person during the pandemic. 

“We now ask the UK government to listen to the data, evidence and voices collected and make telemedicine a permanent service so that women and pregnant people can continue to choose the abortion care they want, need and deserve.”

 Dr Nabanita Ghosh, Medical Director at NUPAS, said: “This ground-breaking study is clear evidence in itself that telemedicine is a wholeheartedly safe and immensely effective method in abortion care 

“We, as providers, have a duty to make abortion care as accessible and safe to our patients as possible , and telemedicine has undoubtedly proven the way forward.

“We call upon the UK Government to realise that if we do not implement this new way forth in abortion care, after the raging tides of COVID-19 have finally subsided, our patients will unfortunately return to potentially reduced access to abortion care for years to come. We cannot afford to look back anymore .”

Dr Tracey Masters, abortion care lead at the Faculty of Sexual and Reproductive Healthcare (FSRH) said: “The data shows that telemedicine has enabled thousands of women to access safer abortion care during a time when travel and face-to-face consultations needed to be severely restricted due to risk of COVID-19 infection.

“I truly hope this will continue because in my clinic I have experienced the benefits of telemedicine for abortion care first-hand. Through telemedicine, my patients have been able to discuss their options and start treatment in a timely manner mostly following a simple remote consultation. Patients are satisfied. They can get high-quality care with confidence and from the comfort of their own home.

“Allowing home use of the first abortion pill, mifepristone, for early medical abortion avoids unnecessary visits to clinic where there is no need for a scan – as is the case for the majority of women in early pregnancy. Home use enhances women’s options and gives better access to a basic, evidence-based and effective treatment. 

“We urge the Government to allow home use of mifepristone and telemedicine for early medical abortion on a permanent basis, to increase the safety and the quality of care.”

Dr Edward Morris, President at the Royal College of Obstetricians and Gynaecologists, said: “This study supports what we have been saying since the start - that early medical abortions at home are safe, more accessible and crucially kinder for women.

“We are aware there has been erroneous and misleading information circulating about this service and it has been creating a toxic discourse. This isn’t fair for the 200,000 people seeking abortions every year in the UK who deserve the best service available to them. 

“We urge the UK government take on board the findings of this study and the medical grounding it provides, and to make the telemedicine service permanently available to women.”

 ENDS 

Notes to Editors

For media enquiries please contact the RCOG press office on +44 (0)7986 183167 or email pressoffice@rcog.org.uk 

To read the study ‘Effectiveness, safety and acceptability of no-test medical abortion provided via telemedicine: a national cohort study’ authored by Aiken, A., Lohr, P., Lord, J., Ghosh, N., Starling, J.,published by BJOG visit https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16668).