What is medical abortion care?

A medical abortion is an abortion where a person ends a pregnancy using a combination of two types of medication, mifepristone and misoprostol, or by using misoprostol alone. Medical abortion care comprises three different phases: pre-abortion, abortion, and post-abortion. These phases include different care components. The pre-abortion phase includes pre-abortion information, counselling, if desired, and eligibility assessment. The abortion phase includes instructions for, dispensing of, and administration of medications. The post-abortion phase includes the assessment of whether the abortion was successful and may also involve linkages to other reproductive health services. Some care components, such as information provision, counselling, and contraceptive counselling if desired, cross-cut all three phases.

What is telemedicine for medical abortion?

Telemedicine is a service delivery model for abortion where care is provided by a health worker using telecommunications, such as online chat, text messages, phone, or videoconference, to deliver care. This review focuses on telemedicine models for the provision of medical abortion care. Telemedicine can be used to support a woman either for part of or for the entire abortion process, from the pre-abortion to post-abortion phase.

What did we want to find out?

Previous research suggests that telemedicine models for medical abortion may be safe, effective, and acceptable to abortion seekers. However, existing data are constrained for reasons relating to self-reporting of outcomes, lack of comparison groups, and missing data, and therefore conclusions must be drawn with caution. In this review we aimed to build a more robust evidence base by investigating models using telecommunications to deliver care relating to one or more phases of an abortion. Our main interests were models of care in which telecommunications were used as the main means of service delivery from the pre-abortion phase to the post-abortion phase, compared with in-clinic care for the corresponding phases. We were also interested in models of care in which telecommunications were used to deliver care in a single phase or for a combination of two phases of an abortion.

What did we do?

We looked for studies comparing telemedicine for medical abortion with in-clinic care.

What did we find?

In total, we found 22 studies, including a total of 131,278 individuals undergoing medical abortion in the first trimester. These studies were conducted across 10 middle- and high-income countries and provided evidence on three interventions: pre- to post-abortion telemedicine models for medical abortion (nine studies); pre-abortion/abortion telemedicine models (four studies); and post-abortion telemedicine models (nine studies). The types of telecommunications used varied across the included studies and contained both synchronous (real-time) and asynchronous (not occurring in real-time) communication.

Main results

We found that pre- to post-abortion telemedicine models for medical abortion are probably similar in terms of their effect on the outcomes of successful abortion, unintended pregnancy, and adherence to the medical abortion regimen, when compared to in-clinic care. This was consistent with our findings relating to the comparisons of pre-abortion/abortion telemedicine models with in-clinic care, and post-abortion telemedicine models with in-clinic care. With regard to post-abortion telemedicine models, we saw that these models likely result in higher rates of adherence to follow-up procedures when compared to in-clinic care. Altogether, our findings indicate that the use of telemedicine for medical abortion in early pregnancy may result in similar outcomes in terms of safety, effectiveness, and acceptability when compared to in-clinic provision.

What are the limitations of the evidence?

Sufficiently large randomised studies and non-randomised studies with appropriate analyses were relatively few, especially for our main intervention of interest. Most studies were conducted in high-resource settings and the majority of included participants were at up to nine weeks' gestation. Most studies included some in-clinic care to confirm the gestational age or the abortion outcome. For our main intervention of interest, however, five out of nine studies did not perform routine ultrasounds, laboratory tests, or physical exams to confirm gestational length or pregnancy location prior to the abortion.

How up-to-date is this review?

The evidence is up-to-date to 13 August 2024.