Medical abortions done at home using pills and an online telemedicine service appear to be just as safe and effective as those done at legal clinics, a new study has found. And it's an approach that the Canadian health-care system may be able to learn from, the author of an accompanying editorial says.
To conduct the study, researchers analyzed the outcomes of 1,023 women in Ireland and Northern Ireland who sought medical abortion services through Women on Web, a non-profit organization that provides access to medications used to induce abortion, between 2010 and 2012. Outcomes were known for 1,000 of those women, and nearly all the women were less than nine weeks into their pregnancy.
Almost 95 per cent of the women reported successfully ending their pregnancy without surgical intervention, such as vacuum aspiration.
The researchers said less than one per cent reported side-effects like nausea and fever — comparable to the rates for women who seek medical abortions at legal clinics. Seven women needed a blood transfusion and 26 received antibiotics. No deaths were reported.
The results were published Tuesday in the online issue of BMJ, formerly the British Medical Journal.
"Among women in the Republic of Ireland and Northern Ireland, early medical abortion provided through online telemedicine was highly effective," lead author Dr. Abigail Aiken and her co-authors wrote.
"The reported rate of successful medical abortion compares favourably with the rates of those carried out within the formal health-care system."
The main limitation of the study, the authors note, is that they had to rely on the women's self-reporting of outcomes and complications.
While abortion medications were sent to a total of 1,636 women, followup information was only available for 1,158, the researchers said. That missing outcome data for almost one-third of the women "represents important uncertainty," the editorial writers say, noting it is aggravated by the international laws governing telemedicine.
Equitable access for all
Abortion laws in both the Republic and Northern Ireland are among the most restrictive in the world, according to the U.S.-based Center for Reproductive Rights.
Millions of women around the world live in countries where self-sourced medical abortion is a potentially life-saving option, the study's authors note, and medical abortion offers an alternative to dangerous methods, such as using sharp objects or noxious substances.
Dr. Wendy Norman, with the University of British Columbia's department of family practice, and Bernard Dickens, a professor emeritus of health law and policy at the University of Toronto, wrote the editorial accompanying the study.
"What this study adds is an important exploration of whether women in jurisdictions with severe restrictions on abortion, but good access to high-quality health care, will self-assess and manage potential complications," they wrote.
Importantly, Norman and Dickens said, 95 per cent of women who were advised to seek local medical care did so.
Canadian women could also benefit from using telemedicine to access medical abortion, Norman says.
In an email to CBC News, she said there is much to learn from the Irish study "to improve the equitable ability of Canadian women to access abortion services."
The home abortion pill Mifegymiso first became available in Canada in January. It is approved for use in the first seven weeks of pregnancy.
Mifegymiso — also known as RU-486 — is a two-step process that involves taking separate medications: mifepristone blocks the hormone progesterone, while misoprostol induces a miscarriage.
Since health care is available in most of Canada's rural areas, but abortion services aren't always accessible, Norman suggests women in these areas could use telemedicine to connect with a doctor and safely terminate their pregnancies at home.
As Canadian women would not need to access international online services, such as those offered by Women on Web, Norman says the physician could be in the nearest large city.
In their editorial, Norman and Dickens also state that while repealing legal restrictions for Irish women would be the safest and most equitable, telemedicine can offer a "reasonable alternative" in the interim.
"Until then, for the first time in history, women of all social classes in a legally restricted, yet high-resource setting have equitable access to a reasonable alternative: medical abortion guided by physicians through telemedicine."