New research shows telemedicine increases access to safe abortion care

The study was a joint collaboration between the University of Cape Town (UCT) and Karolinska Institutet, a research-led medical university in Stockholm, Sweden. File Picture: Leon Lestrade/African News Agency (ANA)

The study was a joint collaboration between the University of Cape Town (UCT) and Karolinska Institutet, a research-led medical university in Stockholm, Sweden. File Picture: Leon Lestrade/African News Agency (ANA)

Published Sep 30, 2022


Cape Town - New ground-breaking research into accessing safe abortion services in South Africa has revealed telemedicine abortion to be safe and effective.

The research also showed telemedicine to be a viable alternative to conventional medical procedures, especially for women in under-resourced settings.

This emerge after scientists completed the world’s first randomised control trial (RCT) into the efficacy of telemedicine abortion - a medication-based abortion that generally relies on a two-drug combination, and is aimed at women in their first trimester.

The study was a collaboration between the University of Cape Town (UCT) and the Karolinska Institutet, a research-led medical university in Stockholm, Sweden.

According to Dr Magit Endler, a consultant in obstetrics and gynaecology at the Karolinska Institutet and an adjunct senior researcher in UCT’s School of Public Health and Family Medicine, abortion is an essential part of a woman’s reproductive rights.

Yet, in South America access to abortions remains restricted despite its liberal abortion laws.

She said the trial specifically targeted women in rural communities where ultrasound scans were not easily accessible or the service was not within reach of the people.

“We are very proud because this is the first RCT performed on telemedicine abortion and is also just one of a handful of studies that investigates telemedicine abortion in low-resource settings.

“We are thrilled with the results, which show that this model for abortion care is safe and effective when compared to the standard care option. This research opens up new avenues of access to care, especially for women who have limited access to healthcare,” Endler said.

About 900 pregnant women who needed access to medical abortions at public health facilities in Cape Town were part of the clinical trial.

The first group of 450 women were randomly selected for the standard care option and received in-person consultations with a healthcare worker.

An ultrasound was conducted to assess the stage of pregnancy and later facilitated the abortion in the clinic.

The remaining 450 women were selected as participants in the telemedicine abortion model intervention.

The women were required to complete an online questionnaire that was reviewed by a doctor and once the patient was approved to proceed with terminating the pregnancy, four separate messages were sent via Facebook Messenger detailing what to do at home.

The messages included guidelines on what to expect after taking both pills and highlighted red flags to look out for.

After this process, the patient was required to visit the clinic where a nurse palpated her uterus in preparation for the abortion and supplied both abortion pills to take home.

“We found that this asynchronous online consultation and instruction for medical abortion, with uterine palpation as the only in-person component, followed by home self-medication, was non-inferior to standard care. It also did not affect safety, adherence or satisfaction,” Endler said.

In August, Endlers paper: “A telemedicine model for abortion in South Africa: a randomised, controlled, non-inferiority trial” was published in Lancet.

According to UCT, the research was conducted against the backdrop of some startling findings on abortions. Even though the procedure is legally performed at public healthcare facilities in the country, half of all abortions in South Africa are estimated to be performed by unlicensed providers. For many women, using formal services remains a no-go as a result of abortion-related stigma.

It said about 8% of global deaths during pregnancy occur as a consequence of unsafe abortions.

“Abortion care consists of several fundamental components: counselling and providing the necessary information the patient needs; screening for eligibility, which includes an assessment on the duration of the pregnancy; providing a set of clear guidelines on how to perform the abortion at home; issuing the medication and conducting a follow-up examination post-procedure in a clinic.

“Because some of these components can easily be performed remotely, South Africa should prioritise its call for telemedicine abortion.

“This model could be used at clinic sites without access to ultrasound scans. It could also be used in resource-constrained settings where abortion is legally restricted,” Endler said.

She said the model allows women to start the process in the comfort of their home or in an environment that they’ve chosen themselves. Interestingly, Endler said most women who participated in the research study reported they preferred the telemedicine model of care for abortions.

“This shows that online consultation and instruction is something women understand and are able to use confidently.

“We sincerely hope that this research can add to the existing momentum that’s already been created to expand telehealth as a way to increase access to abortion in South Africa,” Endler added.

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