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Australia’s Medical Termination Provider

Telemedicine could expand access to medical abortions

Mar 28 2016

Reuters Health reported that in an article published in the Journal American Medical Association that women in the U.S. would now have an easier time getting medical abortions consulting with doctors online instead of scheduling in-person visits.

Although surgical abortions require clinic visits, roughly one half of abortions in USA are now done with medication and these might be provided with telemedicine. Dr Elizabeth Raymond of Gynuity Health Projects in New York and colleagues reported that ”The use of telemedicine is growing. It has tremendous potential to make many essential services more accessible, more convenient and cheaper. Medical abortion is such a service.”

For many U.S. women, obtaining an abortion is difficult because they live at least 100 miles away from the nearest clinic, the authors noted. Mississippi, Missouri, South Dakota and North Dakota each only have one abortion clinic, and Wyoming has none. Medical abortions performed before 10 weeks of gestation with two drugs – mifepristone and misoprostol – can be self-administered at home.

Healthcare providers can use telemedicine to interview patients and assess potential safety issues by reviewing lab test results and ultrasounds before prescribing medication, the authors noted.

In the two-step medical abortion regimen typically used in the U.S., women first take mifepristone. This pill works by blocking the hormone progesterone, which causes the lining of the uterus to break down and makes it impossible for the pregnancy to continue. Then, 24 to 48 hours later, women take misoprostol, which causes the uterus to empty. In rare cases when ultrasound or a blood test shows the medical abortion didn’t succeed, women require a surgical abortion.

In 2008, a Planned Parenthood affiliate in Iowa initiated the first formal telemedicine abortion program in the U.S. with physicians reviewing labs and imaging then speaking to patients to determine if the clinic should be authorized to dispense medical abortion pills. In the first year, this program nearly tripled the number of sites in Iowa offering abortion services, from six to 17, the researchers reported.

Among 233 women with follow-up, the treatment was successful 99 percent of the time. One patient had a blood transfusion in an emergency department, and there were no other serious adverse events reported. Direct-to-patient telemedicine programs for medical abortions are available in the Canadian province of British Columbia and in Australia.