New research from UC San Francisco reveals that medication abortion patients who receive pills by mail without undergoing an ultrasound perform just as well as those who are examined and provided the drugs in person.
The study published in JAMA on June 24 adds to the existing evidence from UCSF’s Advancing New Standards in Reproductive Health (ANSIRH) program that utilizing telehealth for medication abortion is both safe and effective.
Despite a recent Supreme Court ruling upholding FDA guidelines allowing remote prescribing and delivery of medication abortion, the decision was limited due to the lack of standing by the plaintiffs to sue.
These guidelines have facilitated the delivery of medication abortion through telehealth, enhancing access to care in recent times. With the narrow ruling, further legal challenges to medication abortion are anticipated.
Following the revocation of the constitutional right to abortion in 2022, several states have imposed restrictions, leading to medication abortion constituting about two-thirds of all abortions in the U.S. healthcare system.
Lead author of the study, Lauren J. Ralph, PhD, MPH, Associate Professor of Obstetrics, Gynecology, and Reproductive Sciences at UCSF, stated, “This study contributes to the growing evidence supporting the effectiveness and safety of medication abortion through telehealth and mail delivery.”
Ralph further noted, “Patient history-based models of medication abortion care without requiring an ultrasound and via telehealth provide a safe, effective, and urgently needed solution to overcome logistical and geographic barriers to accessing abortion services.”
Evaluation of the “No-Test” Protocol
Researchers examined the outcomes of 585 patients in clinics across several states from May 2021 to March 2023. The patients were divided into three categories for assessment.
The first group underwent a telehealth evaluation for medication abortion eligibility. They were assessed using a “no-test” method based on patient history without an ultrasound and received their medication by mail (288 patients). The second group followed the “no-test” approach and received medication in person (119 patients). Finally, the third group had an ultrasound and obtained medication in person (238 patients).
All participants received the mifepristone and misoprostol regimen to induce abortion. The study highlighted the safety and effectiveness of mifepristone, the sole FDA-approved drug for medication abortion, which was central to the Supreme Court case.
The researchers observed a 95% completion rate for abortion procedures without the need for repeating the regimen, with telehealth patients showing outcomes equivalent to those receiving in-person care. Serious adverse events were uncommon across all groups.
Medication abortion is permitted up to 10 weeks (70 days) into pregnancy, and Ralph emphasized that patients can provide adequate information about their history to determine their pregnancy stage without an ultrasound.
“Embracing care models that utilize telehealth screening without testing and mail delivery of medications prove as effective as in-person care with ultrasound and should be accessible to all pregnant individuals,” Ralph recommended.
Research Validates Unnecessity of Restrictions
The recent Supreme Court case aimed to reverse guidelines that have expanded the availability of medication abortion, including the FDA’s 2021 decision to eliminate the in-person dispensing requirement for mifepristone.
Previous research by UCSF highlighted the safe and effective delivery of medication abortion via telehealth, with another study demonstrating that mail delivery of pills is equally effective as in-person pickup.
Director of ANSIRH and senior author of the latest study, Daniel Grossman, MD, UCSF Professor of Obstetrics, Gynecology, and Reproductive Sciences, emphasized, “Scientific evidence confirms that telehealth evaluation and pharmacy dispensing of abortion pills are safe and effective, and any attempts to restrict these methods are not grounded in science.”
Authors: Additional authors from UCSF include C. Finley Baba, MPH, and M. Antonia Biggs, PhD.
Funding: The study received support from grants provided by the DeMartini Foundation and The Susan Thompson Buffett Foundation.
