New study shows medication abortion via telemedicine is as safe as in-person provision

September 2017

In a landmark study that reviewed seven years of patient data, researchers at the University of California San Francisco (UCSF) and Ibis Reproductive Health have demonstrated that medication abortion provided by telemedicine is just as safe as when women are in the same room as the physician.

The study looked at data from Iowa patients who received a medication abortion either via telemedicine or in person from 2008 to 2015, including any reports of serious complications, including visits to the emergency department where treatment was given. Of the nearly 20,000 patients studied, only 49 complications were reported, and there was no difference in the complication rate between women who had an in-person visit and those who received the service via telemedicine.

“This study included a large number of patients, so we can definitively conclude that telemedicine provision of medication abortion is not associated with a higher risk of complications compared with in-person provision,” said Dr. Daniel Grossman, the director of Advancing New Standards in Reproductive Health (ANSIRH) at UCSF and study co-author. “These findings add to our previous research demonstrating that telemedicine medication abortion was just as effective as meeting with the physician in person, and satisfaction was also high among the women studied.”

Women who receive abortion care via telemedicine undergo the same evaluation as those with an in-person visit, including having an ultrasound, which is viewed remotely by the physician. The doctor meets with the patient by secure videoconference, and if she is eligible, the doctor remotely dispenses the medication. Women return to the clinic about one week later to confirm that the abortion was successful.

Eighteen states have banned the use of telemedicine to provide abortion, citing alleged concerns about safety. In 2008, Planned Parenthood of the Heartland in Iowa began offering medication abortion at health centers without a physician on site in order to improve access to abortion for those living in areas with few or no abortion providers. The Iowa Board of Medicine imposed a regulation in 2013 that prohibited telemedicine medication abortions. Planned Parenthood filed a legal challenge to the ban, and in 2015, the Iowa Supreme Court issued a unanimous ruling blocking the regulation and allowing telemedicine abortion care to continue.

“Our findings provide additional evidence that there is no justification to restrict access to medication abortion by banning the use of telemedicine to provide the service,” said Dr. Grossman. “In fact, our previous research found that the telemedicine service in Iowa improved access to early abortion and was associated with a reduction in second-trimester abortion. From a public health perspective, once a woman has decided to have an abortion, she should be able to access care as early in pregnancy as possible, when it is safer and easier for her.”

“Telemedicine is being used for a wide range of health services—from mental health care to specialist consultation to remote surgery,” said Kate Grindlay, an Associate at Ibis Reproductive Health and study co-author. “Medication abortion is another opportunity to use this technology, and now we have clear evidence of the safety of this model of care.”

Medication abortion has become increasingly popular since it was approved in 2000, and it now accounts for almost half of eligible abortions. The regimen, which is used up to 10 weeks of pregnancy, involves taking one pill of mifepristone, followed by four pills of misoprostol, usually 24 to 48 hours later. Women’s experience with medication abortion is similar to that of a spontaneous miscarriage.

The study was published online in Obstetrics & Gynecology, the official journal of the American College of Obstetricians and Gynecologists and will appear in print on Thursday, Sept. 21. To learn more about Ibis's work on telemedicine provision of medication abortion, visit our project page.