Telemedicine Services for Medical Abortion

Are telemedicine-based models for medical abortion safe, effective, and acceptable alternatives to in-clinic care for pregnancies up to 12 weeks' gestation?

Telemedicine-based models of care, compared with in-clinic care, result in similar rates of successful abortion, adherence (eg, to medication regimen, follow-up plan), and continued pregnancy.¹ (Strength of recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.)

Telemedicine-based models of care compared with in-clinic care result in little to no difference in rates of blood transfusion, emergency department visits, or patient satisfaction.¹ (SOR: B, inconsistent or limited-quality patient-oriented evidence.)

One in five pregnancies in the United States, excluding miscarriage, end in induced abortion.² Despite this high prevalence, access to abortion care remains limited for many patients.^3,4 Telemedicine-based models of care can expand access to timely care while reducing the logistical burdens of traditional in-person visits.⁵ In the United States, telemedicine models of care are increasingly being used to deliver abortion services. By the end of 2024, one in four abortions included telemedicine-based care.⁶ The authors of this Cochrane review examined whether telemedicine-based care for medical abortion varies in safety, effectiveness, and acceptability compared with in-clinic care.¹

This review analyzed 22 studies (six randomized controlled trials [RCTs] and 16 nonrandomized studies) encompassing 131,278 patients seeking medical abortion up to 12 weeks' gestation.¹ Medical abortion was defined as the use of abortifacient drugs (ie, combination mifepristone and misoprostol, misoprostol alone) to end a pregnancy. This review evaluated three models that used telemedicine to deliver care during one or more phases of medical abortion: pre- to postabortion, pre-abortion/abortion, and postabortion.

The preabortion phase included providing information about abortion and an eligibility assessment. The abortion phase involved instructions for, dispensing of, and administration of medication. The postabortion phase included assessment of abortion completion. Telemedicine services included using traditional telephone or video calls, text messages, or online chat services to provide medical care. Synchronous and asynchronous communication methods were used.

The primary outcome was successful abortion, defined as pregnancy termination without need for surgical intervention. Secondary outcomes focused on safety (ie, need for blood transfusion, hospitalization, emergency department visits) and acceptability (ie, patient satisfaction, adherence to treatment and follow-up). Studies were conducted across a mix of middle-and high-income countries (four and five studies, respectively). Meta-analyses were performed only for RCTs. Nonrandomized study findings were summarized descriptively using risk differences with 95% CIs.

The authors found that telemedicine-based care used across all phases of medical abortion management (pre- to postabortion) probably results in little to no difference in successful abortion compared with in-clinic care (two RCTs, n = 837; seven nonrandomized studies, n = 83,061; moderate-certainty evidence).¹ Comparing these two models also resulted in little to no difference in rates of continued pregnancy (five non-randomized studies; n = 74,269; moderate-certainty evidence) or on adherence to the medical abortion regimen (one RCT; n = 732; moderate-certainty evidence). Furthermore, there was little to no difference in rates of blood transfusion, emergency department visits, and patient satisfaction (defined as patients reporting being somewhat satisfied, satisfied, or very satisfied with the abortion care services at 6-week follow-up). There was no apparent difference in hospitalization rates; however, the evidence was very low certainty.