Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study

Aiken, Abigail R.A.; Romanova, Evdokia P.; Morber, Julia R.; Gomperts, Rebecca

doi:10.1016/j.lana.2022.100200

Cited by 58 publications

(52 citation statements)

References 24 publications

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“…[119][120][121] In the current environment of worsening abortion access, attention is turning to SMA. 122 SMA can include self-sourcing and ingesting mifepristone and misoprostol, misoprostol alone, other medications or pills, herbs, toxic substances, or physical methods (ie, trauma or inserting foreign objects into the uterus). 123 Approximately 7% of pregnancy-capable people in the United States have attempted SMA during their lifetime.…”

Section: Therapeutic Advancesmentioning

confidence: 99%

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Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era

Schmidt

Katz

Stein³

2022

American Journal of Therapeutics

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Background:The U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022 effectively overturned federal constitutional protections for abortion that have existed since 1973 and returned jurisdiction to the states. Several states implemented abortion bans, some of which banned abortion after 6 weeks and others that permit abortion under limited exceptions, such as if the health or the life of the woman is in danger. Other states introduced bills that define life as beginning at fertilization. As a result of these new and proposed laws, the future availability of mifepristone, one of two drugs used for medical abortion in the United States, has become the topic of intense debate and speculation.Areas of Uncertainty:Although its safety and effectiveness has been confirmed by many studies, the use of mifepristone has been politicized regularly since its approval. Areas of future study include mifepristone for induction termination and fetal demise in the third trimester and the management of leiomyoma.Data Sources:PubMed, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization.Therapeutic Advances:The use of no-touch medical abortion, which entails providing a medical abortion via a telehealth platform without a screening ultrasound or bloodwork, expanded during the COVID-19 pandemic, and studies have confirmed its safety. With the Dobbs decision, legal abortion will be less accessible and, consequently, self-managed abortion with mifepristone and misoprostol will become more prevalent.Conclusions:Mifepristone and misoprostol are extremely safe medications with many applications. In the current changing political climate, physicians and pregnancy-capable individuals must have access to these medications.

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Section: Therapeutic Advancesmentioning

confidence: 99%

“…Underscoring the safety of this method, less than 1% had complications, with 0.6% requiring a blood transfusion, and 0.5% receiving intravenous antibiotics. 122…”

Section: Therapeutic Advancesmentioning

confidence: 99%

Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era

Schmidt

Katz

Stein³

2022

American Journal of Therapeutics

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“…The advent of medication abortion, using mifepristone and misoprostol in combination or misoprostol alone, allows people to safely and effectively end pregnancy with the same regimens used in a clinic or medical office (Table ). [3][4][5][6][7] Provided people have information about how to use these medications correctly, including how to screen for eligibility, the medical risks of self-managed abortion are likely to be minimal; however, the legal risks may be substantial. As of 2018, more than 20 people reportedly have been criminally investigated, arrested, or imprisoned in the US for allegedly selfmanaging their abortion or helping someone else do so.…”

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confidence: 99%

The Impending Crisis of Access to Safe Abortion Care in the US

2022

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If the recently leaked ruling from the US Supreme Court in Dobbs v. Jackson Women's Health Organization is any indication of the future of abortion care in the US, Roe v. Wade will soon no longer be the law of the land, and access to care will be determined by state laws. It is estimated that about half of states will ban abortion, putting an essential, time-sensitive component of comprehensive health care out of reach. 1 People needing abortions in states with bans will have few options: seek abortion in other states, self-manage their abortion, or carry the pregnancy to term. States where abortion remains legal and accessible will likely see an influx of patients seeking care, perhaps traveling 500 miles or more. For many, this journey will not be possible. As most people obtaining abortions in the US have incomes less than 200% of the federal poverty level, 2 long-distance travel will be a major obstacle. The tremendous financial and other support provided by organizations that facilitate the timely referral of patients will be unable to meet the need.Self-managed (or self-induced) abortion looks very different in 2022 than it did during the pre-Roe era, when people commonly inserted objects into the cervix or ingested toxic substances. The advent of medication abortion, using mifepristone and misoprostol in combination or misoprostol alone, allows people to safely and effectively end pregnancy with the same regimens used in a clinic or medical office (Table ). [3][4][5][6][7] Provided people have information about how to use these medications correctly, including how to screen for eligibility, the medical risks of self-managed abortion are likely to be minimal; however, the legal risks may be substantial. As of 2018, more than 20 people reportedly have been criminally investigated, arrested, or imprisoned in the US for allegedly selfmanaging their abortion or helping someone else do so. 8 People have been charged with various crimes, including homicide, criminal abortion, aggravated fetal assault, procuring a miscarriage, and improper disposal of fetal remains. 8 As the legal environment becomes more restrictive, the frequency of criminal charges against people suspected of self-managing their abortion is likely to increase. It is also possible that people who merely experience pregnancy loss may face criminal charges, as the clinical presentation of spontaneous miscarriage is often identical to the presentation of abortion induced with medication. 9 Most people living in states that ban abortion who would have sought the procedure if it were available will likely be forced to continue their pregnancy to term. Compared with abortion, continuing a pregnancy is associated with increased morbidity and mortality. 10,11 According to one estimate, a total ban on abortion would be followed by a projected 21% increase in maternal mortality overall and a Box. Resources to Assist Patients Seeking Information About Abortion Care or Legal SupportNational Abortion Federation Hotline: information about abortion care prov...

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“…Data show that medication self-management is safe and effective, but the experience may also be isolating and fraught due to shipment delays, fear of telling others, and a feeling of being cut off from help and support within the formal healthcare setting 789. Moreover, while very few states have laws that explicitly criminalise self-management, unjust prosecutions have occurred, with people from ethnic minorities and people with low incomes at disproportionate risk 10…”

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confidence: 99%