How Safe Are At-Home Medical Abortions?
In the United States, a woman can opt to have an abortion with a combination of pills - instead of with a surgical procedure - up to 10 weeks into a pregnancy. Called a medication abortion, the process involves taking mifepristone and misoprostol to terminate a pregnancy without any anesthesia needed. The procedure is 95 percent effective and incredibly safe - less than 1 percent of all women who take the "abortion pill" experience serious side effects. It's also relatively simple, as far as medical procedures go. Take 200 milligrams of one pill, and then 24 to 48 hours later, take 800 micrograms of another.
Yet despite being a fairly straightforward process, current FDA regulations still require that women begin the procedure in a medical center, where the first pill must be administered under the supervision of a health-care provider. This means that for women who live in states with one or very few abortion clinics - or who live in rural areas far from any nearby clinics - obtaining a medical abortion is difficult, if not virtually impossible. In an attempt to improve access for such women, a telemedicine provider in Australia recently carried out a study that tested the safety and efficacy of administering abortion pills to women over the phone, without any face-to-face doctor visits. The study revealed something preexisting studies confirm time and time again - abortion via telemedicine is both safe and effective.
As reported by the Sydney Morning Herald, the Tabbot Foundation, a telemedicine organization in Australia, administered abortion pills over the phone to 1,800 women over the course of 18 months. A preliminary, independent review of the first 1,000 women found that the effectiveness of the procedure at home was incredibly comparable to effectiveness in a brick-and-mortar health-care setting.
In this Australian study, women called a 1-800 phone number, paid $250 out-of-pocket, had an ultrasound and blood test at a local clinic, and were then mailed mifepristone and misoprostol, as well as antibiotics, painkillers, and anti-nausea drugs. A nurse was expected to call a day later to check in on each woman, and 10 days after taking the pills, each woman was meant to have a blood test to make sure the abortion was successful. Of the 1,000 women in the preliminary review, 717 said they took the pills. Normal, complication-free terminations were confirmed for 82 percent of the women. Only two women (0.3 percent of the study sample) had viable pregnancies after taking the supplied abortion pills.
In Australia, where laws regarding the administration of abortion pills are different than in the United States, telemedicine looks to be an effective and convenient way to surmount the access barriers to safe abortion. Women in extremely remote areas, without a clinic nearby to perform an ultrasound or blood test, may still face difficulty, even with telemedicine. But the ability to terminate a pregnancy at home, without traveling to a designated abortion clinic, stands the chance to drastically improve access for women in Australia and the United States.
A pioneer abortion telemedicine study was carried out in Iowa in 2008, though it was slightly different than the Australia study. In Iowa, patients visited a clinic and had a video conference with a health-care provider in an abortion clinic who remotely opened a drawer that contained the pills. The physician then watched the woman take the first pill over the video conference. Anti-abortion politicians tried to ban telemedicine abortion in the state in 2013, saying administering drugs from a remote location was "unsafe," but that ban was ruled unconstitutional two years later.
Medication abortion repeatedly has been proven to be a safe procedure. Yet the pills are still controlled in the U.S. with added regulations that are typically reserved for drugs that cause severe side effects. These regulations, called a Risk Evaluation and Mitigation Strategy, require designated pills only be administered in clinics or medical offices.
"I would hope the FDA would look at the science behind this and make an evidence-based decision," Dan Grossman, a physician and researcher on abortion pill safety, previously told the Los Angeles Times on the subject of abortion pills being so severely regulated. "This shouldn’t be a political decision. It should be based on science, which has very clearly shown this is a very safe drug, safer than ones that don’t have this restriction."
It would currently be illegal for women in the U.S. to receive abortion pills with a simple, over-the-phone consultation, like the 1,800 women in Australia were able to do. But relaxing those restrictions would radicalize access to an evidentially safe procedure for the millions of women who live far from abortion clinics. And with more and more anti-abortion laws being introduced in states every day, the number of women living far from abortion clinics is only increasing.
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