Medication abortion via digital health in the United States: a systematic scoping review
Digital health, including telemedicine, has increased access to abortion care. In recent years, the availability of intelligent digital health solutions has transformed the population and personalized healthcare. 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.
Overview of Medication Abortion Services
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. Medication abortion accounts for more than half (54%) of all abortions before nine weeks gestation in the United States.
Regarding the technological aspect, telehealth and telemedicine allow the delivery of healthcare services such as counseling, assessment, and clinical guidance from a distance through electronic means of communication. They also facilitate a personalized and targeted approach to improve patients’ experience. 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.
Effectiveness and Clinical Outcomes
Studies show that medication abortion care is safe and effective. This scoping review systematically mapped studies conducted on abortion services via telemedicine, including their effectiveness and acceptability for abortion users and providers. The study found that the effectiveness of abortion services via telemedicine was comparable to in-clinic visits, with 6% or fewer abortions requiring surgical intervention.
To summarize the findings based on the systematic review of 33 selected articles published between 2011 and 2022:
| Metric | Data Details |
|---|---|
| Effectiveness | Comparable to in-person provision of abortion services |
| Surgical Intervention | 6% or fewer abortions required intervention |
| Medication Abortion Share | 54% of all abortions before nine weeks gestation |
| Timeline for Use | Up to the first 70 days (10 weeks) of pregnancy |
Acceptability and Motivations for Use
Both care providers and abortion seekers expressed positive perceptions of telemedicine-based abortion services. The convenience, flexibility of appointment times, and ensured privacy to abortion users may make abortion services via telemedicine preferable. Telemedicine offered a preferable option for abortion seekers and providers. 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.
According to the research, the most common reasons for choosing telemedicine included:
- The distance to the abortion clinic
- Convenience and flexibility of appointment times
- Privacy
- Cost
- State laws imposing waiting periods or restrictive policies
However, it is noted that abortion users reported mixed emotions, with some preferring in-person visits.
Regulatory Policy and the COVID-19 Pandemic
The demand for medication and abortion services via telemedicine increased in the United States, particularly following the COVID-19 pandemic. 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.
As the availability of telemedicine has increased, the ability of health providers to offer abortion services using this technology has varied widely. In some locations, only a limited number of abortion services, such as counseling or consenting, were available via telemedicine, while others were offered a wider range of services.