Medication Abortion Through Telehealth Is Safe and Effective

Abstract

In 2000, the US Food and Drug Administration (FDA) approved the medication mifepristone, an antiprogesterone oral medication used with misoprostol to induce abortion. Before mifepristone, most abortions that occurred within the medical system in the US were done using either procedural abortion or medication abortion that used methotrexate or misoprostol only, 1 both of which can have higher adverse event profiles and lower efficacy rates than the mifepristonemisoprostol combined regimen. Mifepristone's approval advanced treatment options for patients needing abortion care and those undergoing miscarriage management, improved the efficacy and availability of medication abortion, and increased the power of patients to manage their own abortions in the place and time of their choosing.Since its initial approval, research on medication abortion using the mifepristone-misoprostol regimen has demonstrated that the efficacy and safety of this regimen mirrors procedural abortion. 2 Patients who choose medication abortion often do so because of a desire to avoid a procedural intervention or due to a feeling that medication abortion is more natural. 3 Currently, the majority of abortion care in the US is done via medication abortion. In 2023, medication abortion accounted for 63% of all abortions occurring in the health care system in the US. 4 However, barriers interfering with patient access to medication abortion remain. Anti-abortion groups have questioned the safety of mifepristone, for example through the recent legal case challenging the FDA's approval of mifepristone (Alliance for Hippocratic Medicine v FDA). In this context, the study by Ralph and colleagues 5 provides crucial evidence.Prior to the COVID-19 epidemic, the FDA required inperson dispensing of mifepristone-misoprostol by a clinician. During the COVID-19 pandemic, the FDA eliminated the requirement for in-person dispensing, enabling medications to be mailed to patients and distributed by certified pharmacies. 6 This change also promoted the use of telemedicine to provide abortion care and medications, thus eliminating multiple barriers to timely care. However, in many states, the requirement for pre-abortion ultrasonography imaging and physical examination remained in place, requiring in-person visits and limiting access.Ralph and colleagues 5 evaluated the safety and efficacy of 2 approaches to medication abortion that do not require inperson visits: (1) a history-based assessment for abortion eligibility with no testing using telehealth and mailing of abortion medications and (2) a history-based assessment (either inperson or using telehealth) with pickup of medications at a pharmacy. Patients receiving in-person assessment with ultrasonog-Opinion EDITORIAL