Latest Evidence on No-Test Medical Abortion

19 February 2021

The British Society of Abortion Care Providers (BSACP) is proud to have initiated, and even more delighted to report, the publication today of the UK’s largest abortion care study, providing definitive data from 52,142 women to support no-test medical abortion via telemedicine.

This study proves without a doubt that early medical abortion (EMA) at home using telemedicine is as safe and effective as traditional methods, and highly valued by the women who participated in the research.

Since the introduction of telemedicine EMA, waiting times and gestations have significantly decreased, with 40% of abortions now provided at less than 6 weeks. Being able to access abortion care earlier in pregnancy has also reduced the low complication rate even further. There was no evidence of inferiority (treatment success 98.8% after telemedicine, 98.2% before), very low incidence of serious adverse events (0.02% vs 0.04%) and equivalent detection of ectopic pregnancy (incidence 0.2%). Patient acceptability was high (96% satisfied, with 80% reporting a future preference for telemedicine).

Providers have reported a major uplift in safeguarding disclosures, including from survivors of domestic and sexual violence. Crucially, telemedicine has provided a lifeline for vulnerable women and girls who cannot attend consultations in person during the pandemic.

The study’s conclusion was that “a telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable, and improves access to care”.

The study is available at: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16668

Two other relevant UK studies have recently been published. One assessed patient acceptability of telemedicine in 1243 patients, confirming that most patients would still chose telemedicine even if COVID-19 were no longer an issue. Reassuringly this study found that nobody reported they were unable to talk privately, and the conclusion was “telemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent”.

This study is available at: https://srh.bmj.com/content/early/2021/02/17/bmjsrh-2020-200954

Colleagues in Scotland have also published their experience of telemedicine. This was a smaller cohort study (n=663) but with robust methodology that followed up all their patients and cross-checked the NHS records to ensure all complications were recorded. Their reported treatment success rate was identical to the English study at 98%. Their conclusion was that “this model of telemedicine abortion without routine ultrasound is safe, and has high efficacy and high acceptability among women”.

This study is available at: Telemedicine medical abortion at home under 12 weeks’ gestation: a prospective observational cohort study during the COVID-19 pandemic | BMJ Sexual & Reproductive Health

In conclusion, BSACP now asks the UK government to listen to the data, evidence and voices collected and make telemedicine a permanent service so that women and pregnant people can continue to choose the abortion care they want, need and deserve.