Large study finds telehealth is as safe as a visit to the clinic for abortion pills

A large national study has found that video visits, texting and mailing pills are all effective, as the U.S. Supreme Court considers limiting access to telemedicine abortion.

Medication abortion can be delivered safely and effectively through telemedicine, according to new research from UC San Francisco that comes as the U.S. Supreme Court is about to hear a case that could severely restrict access to one of the two pills that are used to induce abortions.

Researchers analyzed data from more than 6,000 patients who obtained abortion pills from virtual clinics in 20 states and Washington D.C. between April 2021 and January 2022. They found there were no serious adverse events 99.8% of the time, and that abortions did not require follow-up care 98% of the time. This is similar to what has been found for patients who receive medication abortion at clinics or doctor's offices.

The findings appear in Nature Medicine.

Medication abortion, which now accounts for more than half of all abortions, involves taking two pills—mifepristone followed by misoprostol—and extensive research supports its safety and efficacy. Demand for the pills has increased since more than two dozen states banned or restricted abortion following the June 2022 decision by the Supreme Court to overturn Roe v. Wade, which guaranteed a constitutional right to abortion.

On March 26, the Supreme Court is scheduled to hear arguments over whether the U.S. Food and Drug Administration (FDA), which approved mifepristone in 2000, should roll back rules that in recent years have made the medication more widely available. In 2021, the agency removed the in-person dispensing requirement, allowing health care providers to have abortion pills sent through the mail after an online consultation. Telehealth abortion now accounts for nearly 10% of all U.S. abortions.

"This research confirms that the FDA followed science in allowing patients to get medication abortion through telehealth and the mail," said the study's first author, Ushma Upadhyay, Ph.D., MPH, a public health scientist with Advancing New Standards in Reproductive Health (ANSIRH) at UCSF.

"Our findings make it abundantly clear that the case at the Supreme Court is simply an attempt to restrict access to abortion care, even in those states where it's legal."

Telemedicine promotes privacy and access

The researchers also compared video visits to secure text messaging, and found they were about equally safe and effective. The authors concluded that telehealth protects patient privacy while making abortion more accessible. This has become increasingly important as abortion clinics have closed in states that restricted abortion and wait times have increased elsewhere.

"Since the COVID-19 pandemic, telemedicine has become the new frontier in health care, including for medication abortion," said Upadhyay, who is a professor of Obstetrics, Gynecology & Reproductive Sciences at UCSF. "A ruling against this method and the FDA's rigorous science review process would be a huge blow to the American public and make this essential health service harder to get."

The study has already been cited in the amicus brief submitted to the Supreme Court supported by more than 300 leading reproductive health researchers.