Telemedicine Can Help Vulnerable Women Access Safe Medical Abortions

Author: Karolinska Institutet
Published: 2022/09/07 - Updated: 2023/01/04
Peer Reviewed Publication: Yes
Topic: Telemedicine or eHealth - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: Study shows that medical abortion can be carried out safely and effectively via telemedicine, without a routine ultrasound examination. According to the World Health Organization (WHO), 25 million unsafe abortions are performed every year and up to 47,000 women and girls die as a result. The reasons women seek unsafe abortions include a lack of resources, the stigma surrounding abortion, and restrictive abortion laws.

Defining Abortion

Abortion: Abortion is the termination of a pregnancy by removing or expulsing an embryo or fetus. An abortion without intervention is a miscarriage or "spontaneous abortion." When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently, "induced miscarriage." The unmodified word abortion generally refers to an induced abortion. In the United States, the risk of maternal mortality is 14 times lower after induced abortion than after childbirth. Unsafe abortions - those performed by people lacking the necessary skills or in inadequately resourced settings - are a significant cause of maternal death, especially in the developing world. However, self-managed medication abortions are highly effective and safe. Public health data shows that making safe abortion legal and accessible reduces maternal deaths.

Introduction

A Telemedicine Model for Abortion in South Africa: A Randomized, Controlled, Non-Inferiority Trial

A new study published in The Lancet shows that medical abortion can be carried out safely and effectively via telemedicine, without a routine ultrasound examination. The study, a collaboration between researchers at Karolinska Institutet in Sweden and the University of Cape Town in South Africa, highlights the opportunities to provide safe and effective abortion services in low-resource settings.

Main Item

"As far as we know, our study is the first randomized clinical trial to evaluate telemedicine, meaning care at a distance, in abortion. This method can potentially reduce the number of unsafe abortions, something that is particularly important and relevant in times when the right to abortion is under threat", says Margit Endler, a researcher at the Department of Women's and Children's Health at Karolinska Institutet and consultant at the Department of Obstetrics and Gynecology at Södersjukhuset (Stockholm South General Hospital).

Significant Threat to Women's Health

According to the World Health Organization (WHO), 25 million unsafe abortions are performed every year and up to 47,000 women and girls die as a result. The reasons women seek unsafe abortions include a lack of resources, the stigma surrounding abortion, and restrictive abortion laws. In South Africa, it is estimated that approximately half of all abortions are performed outside the general healthcare system, thus risking the safety of women in need of care.

The present study included 900 women from four clinics in Cape Town, South Africa, who were at or before nine weeks gestation and seeking care for an abortion.

Half received standard care with an in-person consultation and ultrasound and had an abortion initiated with oral medication at the clinic. The other half received treatment through telemedicine. The women filled out an online consultation form, received information and instructions for the abortion procedure via text messages, and took both abortion medications home.

The only in-person component the telemedicine group received was a simple uterine examination (palpation) performed in the clinic as a safety precaution.

Equal to Standard Care

The researchers then compared the rate of successful abortion, continuing pregnancy, adverse events, and satisfaction with the treatment. They found that the women who completed an abortion through telemedicine adhered well to the instructions and achieved treatment results that were as good as the women who received standard care while maintaining similar levels of safety.

"What was interesting was that the majority of women in both groups expressed that they preferred the telemedicine option. This care model can be critical in resource-poor areas without healthcare infrastructure or restrictive abortion laws. For example, women can be examined at a clinic that does not have access to ultrasound and then receive guidance for the abortion remotely", says Margit Endler.

The researchers are now planning another study in Africa to evaluate whether women deemed to have a low risk of complications can completely forego the physical clinic visit.

The research was funded by the Grand Challenges Canada OPTIONS initiative and the Swedish Research Council. One of the co-authors, Rebecca Gomperts, is the founder and director of Women on Web, the telemedicine platform used in the study. No other conflicts of interest are declared.

Publication:

"A telemedicine model for abortion in South Africa: a randomised, controlled, non-inferiority trial". Margit Endler, Gregory Petro, Kristina Gemzell Danielsson, Daniel Grossman, Rebecca Gomperts, Maja Weinryb, Deborah Constant. The Lancet, online 27 August 2022.

Related Information

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by Karolinska Institutet and published on 2022/09/07, this content may have been edited for style, clarity, or brevity. For further details or clarifications, Karolinska Institutet can be contacted at ki.se NOTE: Disabled World does not provide any warranties or endorsements related to this article.