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. 2022 Jun:10:100200.
doi: 10.1016/j.lana.2022.100200. Epub 2022 Feb 17.

Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study

Abigail R A Aiken  1 , Evdokia P Romanova  2 , Julia R Morber  3 , Rebecca Gomperts  2
Affiliations

Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study

Abigail R A Aiken et al. Lancet Reg Health Am. 2022 Jun.

Abstract

Background: As access to clinical abortion care becomes increasingly restricted in the United States, the need for self-managed abortions (i.e. abortions taking place outside of the formal healthcare setting) may increase. We examine the safety, effectiveness, and acceptability of self-managed medication abortion provided using online telemedicine.

Methods: We retrospectively examined records of the outcomes of abortions provided by the sole online telemedicine service providing self-managed medication abortion in the U.S. We calculated the prevalence of successful medication abortion (the proportion who ended their pregnancy without surgical intervention); the prevalence of serious adverse events (the proportions who received intravenous antibiotics and blood transfusion); and assessed whether any deaths were reported to the service. We also examined the proportions who were satisfied and felt self-management was the right choice.

Findings: Between March 20th 2018 and March 20th 2019, abortion medications were mailed to 4,584 people and 3,186 (70%) provided follow-up information. Among these, 2,797 (88%) confirmed use of the medications and provided outcome information, while 389 (12%) confirmed non-use. Overall, 96.4% (95% CI 95.7% to 97.1%) of those who used the medications reported successfully ending their pregnancy without surgical intervention and 1.0% (CI 0.7%-1.5%) reported treatment for any serious adverse event. Among these, 0.6% (CI 0.4% to 1.0%) reported receiving a blood transfusion, and 0.5% (CI 0.3% to 0.9%) reported receiving intravenous antibiotics. No deaths were reported to the service by family, friends, the authorities, or the media. Among 2,268 who provided information about their experience, 98.4% were satisfied and 95.5% felt self-management was the right choice.

Interpretation: Self-managed medication abortion provided using online telemedicine can be highly effective with low rates of serious adverse events. In light of increasingly restricted access to in-clinic abortion in the U.S., it may offer a safe and effective option for those who cannot access clinical care.

Funding: The Society of Family Planning and The National Institutes of Health.

Keywords: Abortion; Online telemedicine; Self-managed; United States.

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Conflict of interest statement

ARAA reports grant support from the Society of Family Planning (Grant # SFPRF12-MA1) and received infrastructure support from the National Institutes of Health (Grant # P2CHD042849). ARAA is a Council Member of the British Society of Abortion Care Providers (BSACP). RG is the Founder and Director of Aid Access, ED is a helpdesk coordinator at Aid Access, and JM interned at Aid Access during her program of study at VU.

Figures

Fig 1
Figure 1
U.S. residents accessing abortion medications through Aid Access.
See this image and copyright information in PMC

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