Even though abortion has been legal nationwide for 44 years, nearly 90 percent of U.S. counties have no abortion provider.
That can force women to travel long distances to terminate a pregnancy.
Breakthroughs in technology and medicine could soon change that statistic.
The rise of medical abortions done via telemedicine means more women may be able to end a pregnancy earlier and without requiring a doctor to be in the room.
However, the safety of this practice has been questioned by some state officials.
Currently, 19 states have effectively banned the procedure by requiring a doctor to be present, according to the Guttmacher Institute.
But, a new study finds there is no discernable risk for people who are given medical abortions via a telemedicine session compared to those who see the doctor in person.
Medical abortion, meaning terminating a pregnancy via the medications mifepristone and misoprostol, has become more common in recent years.
At the same time, telemedicine, where a doctor sees patients via a computer or other screen, has also become more common in a variety of medical fields. This is especially true in areas where access to doctors is difficult.
The combination of the two, or a telemedicine abortion, has been around since at least 2008, when Planned Parenthood started the practice in Iowa.
Studying the safety
In a recent study published in the journal Obstetrics and Gynecology, researchers from the University of California San Francisco (UCSF) wanted to definitively study if there was additional risk to women who pursued a medical abortion via telemedicine compared to women who saw a doctor in person.
Earlier research from the team was done shortly after the procedure started in Iowa. While the findings pointed to the procedure being safe, the team wanted to have more data over a longer time period.
In this study, they looked at all patients who received medical abortions either in person or via telemedicine at Planned Parenthood Centers in Iowa.
They also received data from 42 emergency departments to see if they had treated any women who recently had a medical abortion.
In the seven-year study period from 2008 to 2015, there were 10,405 in-person medical abortions and 8,765 telemedicine abortions.
In total, there were 49 clinically significant adverse events over the seven-year study period. Adverse events could be hospital admission, surgery, blood transfusion, emergency department treatment, or other complications.
None of the emergency departments reported treating a patient who recently had a medical abortion and needed care.
This means that 0.32 percent of women who had an in-person medical abortion and 0.18 percent of telemedicine patients had an adverse event.
There were no deaths or related follow-up surgeries reported.
The importance of the research
Dr. Daniel Grossman, lead author of the study and director of Advancing New Standards in Reproductive Health (ANSIRH) at UCSF, said they wanted to look at the results over a long period of time in order to have a clear idea of the procedure’s safety.
“Particularly after Iowa started this, many states started to pass laws… ostensibly saying it wasn’t safe,” he said.
Grossman explained that Iowa had 17 health centers that provided abortions but just two doctors to give care. As a result, many women had to travel long distances to see the doctors.
“Women really like the service,” Grossman said. “It meant they didn’t have to travel as far or get the appointment sooner.”
Grossman said the findings weren’t surprising, but it was important to give women and also state legislatures a clear indication of the safety around that specific procedure.
“I think a few things that are important to highlight,” Grossman said. “One is just that medication abortion, like all abortion, is incredibly safe… There is a misperception in the public that abortion is a dangerous procedure.”
After the study period ended, Grossman did serve as a consultant to the Planned Parenthood Federation of America and provided input on the implementation of services providing medical abortion using telemedicine.
Megan Donovan, senior policy manager at the Guttmacher Institute, said that the study proved telemedicine is a safe way of providing medical abortion to patients.
“In an environment in which access to abortions is increasingly limited, this technology has great potential to expand access to patients in rural or otherwise underserved communities,” she said.
Donovan said that that this kind of study could be used in legal challenges to current restrictions on abortions.
“Proponents of these restrictions say that these restrictions are about safety. So this study could play a key role in challenging that claim and prompting reform,” she explained.