Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services

Abstract

Women on Web is a service that uses telemedicine to help women access mifepristone and misoprostol in countries with no safe care for termination of pregnancy (TOP). This study reviews the telemedicine service. After an online consultation, women with an unwanted pregnancy of up to 9 weeks are referred to a doctor. If there are no contraindications, a medical TOP is conducted by mail. After maximising the follow up from 54.8 to 77.6%, 12.6% decided not to do the TOP and 6.8% of the women who did the medical TOP at home needed a vacuum aspiration. Telemedicine can provide an alternative to unsafe TOP. Outcomes of care are in the same range as TOP provided in outpatient settings.

A research agenda for moving early medical pregnancy termination over the counter

“…In reports describing these services, most women obtained an ultrasound for gestational age dating but approximately one‐third who were followed up after receiving treatment had pregnancies which were of 10 weeks of gestation or greater by ultrasound 7, 8…”

“…Ideally, these services include trained providers. Reports from Women on Web indicate that women may overestimate complications or require more guidance on what to expect from the termination process given that 12–20% subsequently received a surgical intervention,7, 8, 33 although this may also reflect provider overtreatment or local treatment standards. In contrast, women receiving medical termination from Bangladesh pharmacies reported low rates of seeking medical care.…”

How can a state control swallowing? The home use of abortion pills in Ireland

“…It is also reasonable to assume that many women who have contacted these groups will go on to request abortion pills, and that most of these will go on to use them: once pills are supplied, WoW report a general non-usage rate of around one in ten. 15,16 While these numbers are imprecise, on any reading, they suggest a very substantial health need that is unmet by domestic services, and WoW and WHW are just two of the organisations who will arrange supply of the pills, with evidence from customs seizures confirming that women in Ireland are also attempting to access pills from elsewhere. Neither WoW nor WHW ship directly to the Republic of Ireland yet Irish Customs regularly block attempts to import mifepristone and misoprostol: in 2014, 60 consignments were seized containing 45 mifepristone and 972 misoprostol pills (see Table 2).…”

“…24 Notably, it is growing more common for abortion pills to be supplied via telemedicine and evidence suggests that this can offer an effective provision model. 15,16,25,26 Official Irish advice regarding abortion pills tends towards blanket statements about the dangers of sourcing any pharmaceuticals online or using the pills "without medical supervision". 27,40 Irish media also carry frequent reports drawing attention to purported dangers of home use of pills (see, for example 28 ).…”

Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa

“…The WHO’s technical guidelines on safe abortion from 2012 emphasise the simplification of CAC [6]. An example of simplified care is telemedicine, which should be considered as an alternative service delivery channel for medical abortion [7]; another example is the task shift to nurses and midwives that has occurred in post-abortion care [8,9], which was a pragmatic response to the shortage and uneven distribution of physicians in low- to middle-income countries. Because midwives are key in CAC, scaling up their involvement is an important strategy in expanding access to care.…”