Abortions by Telemedicine and Mailed Pills Are Safe and Effective, Study Finds

The research

The study, led by researchers at the University of California, San Francisco, looked at the experience of more than 6,000 patients in the months after the federal government began allowing abortion pills to be mailed, from April 2021 to January 2022.

The patients used one of three telemedicine abortion organizations — Hey Jane, Abortion on Demand or Choix — that served 20 states and Washington, D.C. The research, published on Thursday in Nature Medicine, ended five months before the Supreme Court overturned Roe v. Wade, igniting a wave of state abortion bans and restrictions. Since then, more telemedicine services have opened, and are used by many patients who consider the method more convenient, private and affordable than visiting clinics or doctors, especially if they have to travel to another state.

The services in the study prescribed pills to patients who were 10 weeks pregnant or less (one service had an eight-week limit) and screened patients for medical issues that would make them ineligible, like ectopic pregnancies or blood-clotting disorders.

In most cases, the services’ doctors, nurse practitioners, physician assistants and midwives were able to determine eligibility from patients’ written or verbal information about their pregnancy and health, without requiring them to have ultrasounds, which are logistically difficult for some patients to obtain. If medical eligibility was unclear, patients were asked to get ultrasounds — 486 did and were then prescribed pills, comprising about 8 percent of the 6,034 patients who received pills in the study.

The results

Researchers reviewed the medical records of the services and were able to determine abortion outcomes for three-fourths, or 4,454, of the patients. A vast majority — 4,351 patients, or 97.7 percent — completed abortions with the standard regimen: mifepristone, which stops a pregnancy’s development, followed a day or two later by misoprostol, which causes contractions to expel the tissue.

Of the remaining patients, 85 needed additional measures to complete the abortion, usually with additional medication or a suction procedure in a medical facility.

Eighty-one patients visited emergency departments, and 15 patients had serious complications. Ten patients were hospitalized. Six received blood transfusions, two were treated for infections and one had surgery for an ectopic pregnancy.

Six patients turned out to have ectopic pregnancies, which would have made them ineligible for the pills. Studies show that ectopic pregnancies cannot always be identified early, even by ultrasound.

Of the patients who visited emergency departments, 38 percent ended up needing no treatment. Patients sometimes visit emergency departments because “they don’t know whether what they’re experiencing is normal and they sometimes don’t have anyone to ask and they don’t want to tell a lot of people about their abortion,” said Dr. Ushma Upadhyay, a public health scientist at U.C.S.F. and one of the study’s authors.

No patients were found to be beyond 10 weeks into pregnancy.

The effectiveness and safety rates were similar to those in several large studies of in-person medication abortion and of telemedicine abortion where ultrasounds were required. They were also similar to the rates on the Food and Drug Administration’s label for mifepristone.

Researchers also found no difference in safety or efficacy for patients who received real-time video consultations compared to those who received prescriptions based on written information they provided via text messaging, which most patients did.

Two patients asked about “abortion pill reversal,” a nonscientific theory that abortions can be stopped after taking the first drug. Both were told that “evidence-based reversal treatment does not exist” and were referred to urgent in-person care, the study reported.

Larger implications

Medication abortion is being challenged in a lawsuit filed against the F.D.A. by abortion opponents seeking to curtail mifepristone. One of the plaintiffs’ claims is that abortion pills are dangerous. The F.D.A. has cited overwhelming scientific evidence that the pills are safe, and two studies that abortion opponents referenced to support their claims were recently retracted by a scientific journal publisher.

In August, an appeals court said mifepristone could remain legal, but ordered significant restrictions that would prevent mailing or prescribing it by telemedicine. The Supreme Court will hear arguments in the case next month. The new study results may be mentioned by those urging the court to keep telemedicine abortion available.