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Initial findings from mail-order medication abortion pilot show initiative is safe, effective

Initial findings from an ongoing project assessing the implications of making medication abortion available outside of a clinical setting indicate the initiative is safe and effective for women seeking abortion care, Kaiser Health News reports.

Background

According to KHN, women in Australia and the Canadian province of British Columbia can access medication abortion by mail after speaking online or by telephone with a health care provider. In addition, multiple international organizations offer mail-order medication abortion to countries that restrict abortion access. One such group, Women on Web, has provided 50,000 women with medication abortion access across 130 countries since 2006 (Galewitz, Kaiser Health News, 11/14).

However, in the United States, the Food and Drug Administration (FDA) allows mifepristone, a drug used in medication abortion, to be dispensed only in clinical settings. FDA's limitation on where the drug may be administered is "unusual," as such restrictions are typically applied only to intravenous medication.

Mail-order medication abortion pilot project

Earlier this year, researchers launched a pilot program that allows four abortion clinics in Hawaii, New York, Oregon and Washington state to provide mifepristone by mail (Women's Health Policy Report, 4/4). The researchers have FDA permission to run the pilot (Kaiser Health News, 11/14).

Gynuity's Erica Chong, Elizabeth Raymond and Beverly Winikoff created the program. Gynuity is a New York-based research group that aims to use technology to increase access to reproductive health care.

The pilot allows a woman, during the first nine weeks of pregnancy, to receive medication abortion pills through the mail. A recipient must reside in the same state as the clinic prescribing the pills. To receive the medication, a woman must first have an ultrasound and a blood test to confirm pregnancy and assess risk. Afterward, a clinician will use video chat to counsel the woman. The pill regimen and counseling are the same as if the medication were dispensed in a clinical setting.

Researchers are also using the pilot to assess whether telemedicine helps reduce costs for a woman accessing medication abortion, as well as whether insurers will reimburse equally for in-person and telemedicine visits.

Depending on how the pilot program goes, the researchers foresee the study expanding to multiple states. However, several states have laws in effect that prevent the use of telemedicine for abortion care, preventing Gynuity from launching its program in those regions (Women's Health Policy Report, 4/4).

Initial findings

According to researchers, 12 women, all of whom live in Hawaii, have participated in the pilot program so far. Of those women, 11 reported no signs of complications and one did not take the pills. Ten of the women completed surveys on their experience, reporting that they were satisfied and would recommend the experience to a friend.

One of the pilot participants, who went by the name Marie to remain anonymous, said she appreciated the program because it enabled to her to complete a medication abortion in the privacy of her home. "I was happy that I was going to be able to do it myself," she said.

In addition, Marie was able to save herself the time and money associated with traveling to the nearest abortion clinic, which is located more than 100 miles away from her home. The at-home administration also meant she could wait to take the drugs until she could arrange time away from work.

Comments

Raymond noted that if the study results find that the telemedicine and mail approach is effective, FDA could be encouraged to lift its restrictions on mifepristone. "All kinds of dangerous drugs are prescribed and available at pharmacies, including drugs for heart disease and Viagra," Raymond said. She added, "There is no justification for why this safe drug should not be in pharmacies now."

However, Danco Laboratories, the manufacturer of the drugs used in the pilot program, said that it does not currently have any plans to ask FDA to let it expand distribution of medication abortion via mail-order access or through pharmacies.

Jessica Arons, president and chief executive of the Reproductive Health Technologies Project, said, "While this has the potential for being the future of abortion delivery for a good segment of the population, that vision might not be fulfilled due to the politics around the issue and restrictions in many states" (Kaiser Health News, 11/14).