Telehealth Medication Abortion Is Safe, Study Says

Medication abortion pills prescribed via telehealth are safe and 98% effective at terminating pregnancy, according to a new study.

Telehealth abortion — prescription of medication abortion pills via telehealth video appointment — has become crucial to addressing surges in demand in states where abortion remains legal after Roe v. Wade was overturned.

The safety of medical abortion is well-established, as only 0.3% of patients experience side effects requiring hospitalization, such as vaginal bleeding, pelvic pain, or infection, according to a meta-analysis of 87 clinical trials. However, the evidence of its safety when provided via telehealth has been limited thus far.

A new study published in the journal Nature Magazine followed over 6,000 pregnant people who obtained medication abortion via telehealth from three virtual clinics between April 2021 and January 2022.

Half of the participants were 30 or older, and 4.6% were under 20 years old. Most (84.3%) patients had pregnancy durations under seven weeks.

The participants took a two-pill regimen of 200 mg of mifepristone and 800 μg or 1,600 μg misoprostol. Most participants (72.3%) received asynchronous care, meaning communication with the healthcare provider involved secure text messaging without a scheduled interaction.

Among 6,034 abortions, 97.7% resulted in a pregnancy termination without subsequent known intervention. The overwhelming majority (99.8%) of abortions did not cause serious adverse events.

Serious adverse events that occurred among 0.25% of patients included blood transfusions and abdominal surgery to treat a ruptured ectopic pregnancy. Some 0.17% of patients had hospital admissions requiring overnight stays.

Overall, 1.3% of abortions were followed by a known emergency department visit, 38.3% of which resulted in no treatment.

How does medication abortion work?

Medication abortion accounts for 53% of all facility-based abortions in the United States and involves taking two different drugs to end pregnancy.

The first, mifepristone, blocks a hormone called progesterone that is needed for a pregnancy to continue. The second one, misoprostol, taken 24 to 48 hours after mifepristone, induces uterine contractions, allowing the body to expel the pregnancy tissue.

The U.S. Food and Drug Administration has approved the use of mifepristone and misoprostol to end pregnancies up to 10 weeks.

The new study and previous research suggest that medication abortion is very safe, although it may have serious side effects. Seek care immediately if you experience one or more of the following symptoms after taking abortion pills:

• Prolonged heavy bleeding
• Severe abdominal or back pain
• Fever lasting more than 24 hours
• Foul-smelling vaginal discharge

In 2021, the FDA removed the in-person dispensing requirement and allowed patients to receive medication abortion pills by mail. As a result, clinicians started offering entirely remote consultations, relying on the patient’s self-reported medical history instead of ultrasonography and other tests to screen for medical eligibility.

The removal of the restriction reduced travel, cost, and stigma-related barriers.

The findings of the new study are consistent with the previous evidence that medication abortion is very safe and effective, even when the pills are prescribed via telehealth.