The Availability and Use of Medication Abortion Care in the United States

Medication abortion, also known as medical abortion or abortion with pills, is an FDA approved pregnancy termination protocol that involves taking two different drugs, mifepristone and misoprostol, for use up to the first 70 days (10 weeks) of pregnancy. Studies show that medication abortion care is safe and effective. Currently, medication abortion accounts for more than half (54%) of all abortions before nine weeks gestation in the United States.

Effectiveness and Safety of Medication Abortion

Previous studies have reported that the effectiveness of abortion services through telemedicine is comparable to that of in-person provision of abortion services. Data from recent research indicates:

• Gestational limit: Protocol is approved for use up to the first 70 days (10 weeks) of pregnancy.
• Prevalence: It accounts for 54% of all abortions before nine weeks gestation.
• Safety: The effectiveness was comparable to in-clinic visits, with 6% or fewer abortions requiring surgical intervention.

Medication Abortion via Digital Health

Digital health, including telemedicine, has increased access to abortion care. The U.S. Food and Drug Administration (FDA) states that digital health is comprised of categories that include health information management (HIM) technology, mobile health (mHealth), personalized medicine, telehealth and telemedicine, and the use of wearable medical devices. Telehealth and telemedicine allow the delivery of healthcare services such as counseling, assessment, and clinical guidance from a distance through electronic means of communication.

Regarding medication abortion services provided outside of inpatient healthcare settings before 12 weeks of gestational age, telemedicine and telehealth technologies present an alternative to in-clinic abortion services. The demand for medication and abortion services via telemedicine increased in the United States, particularly following the COVID-19 pandemic.

Systematic Scoping Review Findings

A systematic scoping review mapped studies conducted on abortion services via telemedicine, including their effectiveness and acceptability for abortion users and providers. Out of 757 retrieved articles, 33 articles were selected based on the inclusion criteria. These studies were published between 2011 and 2022, with 24 published in the last 3 years.

The study found that telemedicine increased access to abortion care in the United States, especially for people in remote areas or those worried about stigma from in-person visits. Both care providers and abortion seekers expressed positive perceptions of telemedicine-based abortion services. The most common reasons for choosing telemedicine included:

• Distance to the abortion clinic
• Convenience and flexibility of appointment times
• Privacy and cost
• State laws imposing waiting periods or restrictive policies

Policy and Regulatory Landscape

On April 12, 2021, the FDA’s Center for Drug Evaluation and Research notified the American College of Obstetricians and Gynecologists (ACOG) that they are suspending enforcement of the Risk Evaluation and Mitigation Strategy (REMS) requirement for mifepristone that requires prescribers to dispense to patients in-person during the COVID-19 emergency. This temporarily allows providers in the 32 states and DC that do not have laws that otherwise ban this practice to dispense mifepristone using the telehealth protocol for medication abortion.

The FDA has also undertaken a full review of the REMS for mifepristone and the results of that review are expected later in 2021. The dispensing of the oral abortifacient mifepristone via telemedicine was originally permitted under an FDA investigational new drug application (INDA) protocol given the FDA restricted its provision via telemedicine and permitted its administration only under the supervision of certified clinicians at a health facility.