International Telemedicine Abortion Service Is ‘Safe, Effective and Acceptable’

Demand for telemedicine abortion is increasing in the face of abortion restrictions and a potential Roe v. Wade overturn. Researchers say that the service is safer and more effective than ever. Patients surveyed reported overwhelmingly positive experiences with telemedicine provider AidAccess, according to a study from the University of Texas.

Research Findings on Safety and Efficacy

New research published in The Lancet definitively shows that people served by Austria-based telemedicine abortion provider Aid Access have had highly positive experiences with the service, with very low rates of complications reported. “This study is the first evidence from the U.S. context that self-managed medication abortion provided using this online telemedicine model is safe, effective and acceptable to users,” says the study’s lead author, Dr. Abigail R. A. Aiken, associate professor at the University of Texas at Austin’s LBJ School of Public Affairs.

Aiken’s research found that between March 2018 and March 2019, Aid Access mailed abortion medications to 4,584 people. Of the 2,797 people who used the medications and responded to a follow-up survey, 96.4 percent reported successfully ending their pregnancy without surgical intervention and only one percent reported any treatment for a serious adverse event, a rate only slightly higher than in clinical settings. Aid Access telemedicine abortion is much safer than carrying a pregnancy to term, says Aiken.

Outcomes by Gestational Age

The research also provided evidence that medication abortion after 10 weeks is effective and safe, although slightly less so than before ten weeks. Regarding the specific success and complication rates found in the study:

• Up to 10 weeks: 97 percent successfully ended their pregnancies, with only 0.08 percent experiencing complications.
• After 10 weeks: 92 percent successfully ended their pregnancies, with 2.3 percent experiencing complications.

“It’s of course higher, but it’s not alarmingly high,” says Aiken, noting that the World Health Organization has approved the use of abortion pills up to 13 weeks of pregnancy.

Operational Model and Access

Dutch physician Rebecca Gomperts founded Aid Access in Austria in 2018 to provide online, telemedicine abortion to people in all 50 U.S. states, including the 19 states that currently prohibit telemedicine abortion. The service requires an online consultation to determine eligibility for using abortion pills, and provides information about how to use abortion pills. Patients in states allowing telemedicine abortion receive care from U.S.-based caregiver who ships medications from Honeybee Health. For patients in states that block U.S. providers from offering this service, Dr. Gomperts sends a prescription to a pharmacist in India, who ships the medications directly to them.

Dr. Gomperts charges a sliding scale fee up to $110. She has served over 30,000 people in the U.S. since she began Aid Access four years ago. Patients receive the medications in 2-3 weeks.

User Satisfaction and Clinical Benefits

Respondents reported positively about their experiences of using abortion medication through Aid Access:

• 98.4 percent were satisfied with their abortion experience;
• 95.5 percent said it was the right choice;
• 98.1 percent felt they had enough information on how to use the medications;
• 93.4 percent felt they had enough information on what to expect from the process.

One area of concern is that medication abortion outside of the formal US health care system might delay a diagnosis of an ectopic pregnancy. But Aiken says that they saw the opposite in the study. “We saw that people actually were diagnosed at the time of contacting Aid Access, which is a really good thing,” she says. No ectopic pregnancies were reported after using the medications. The research also showed that patients’ reports of last menstrual period is an accurate method for determining gestation duration in early pregnancy, meaning ultrasounds aren’t necessary.