Telemedicine abortions increase access to safe abortion care

Abortion adverts around Church Square. Picture: Jacques Naude/African News Agency(ANA)

Abortion adverts around Church Square. Picture: Jacques Naude/African News Agency(ANA)

Published Oct 3, 2022


A medication-based abortion that generally relies on a two-drug combination has increased access to safe abortion care in South Africa.

Scientists recently completed the world’s first randomised control trial (RCT) into the effectiveness 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 joint collaboration between academics at UCT and the Karolinska Institutet in Stockholm, Sweden.

According to Dr Margit Endler, a consultant in obstetrics and gynaecology at 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 access to abortions remains restricted in South Africa despite the country’s liberal abortion laws.

The research revealed that telemedicine abortion is safe and effective and a viable alternative to the conventional medical procedure, especially for women in under-resourced communities.

“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 health care,” Endler said.

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

The first group of 450 participants were randomly selected for the standard care option and received an in-person consultation with a health-care worker, while the remainder of participants were selected to participate in the telemedicine abortion model intervention.

The university said they 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, she received four separate messages via Facebook Messenger detailing what to do at home. These messages also included guidelines on what to expect after taking both pills and highlighted the red flags patients needed to look out for. Thereafter, 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.

UCT said that even though the procedure is legally performed at public health-care facilities in the country, half of all abortions in South Africa are estimated to be performed by unlicensed providers.

Because some of these components can easily be performed remotely, Endler said 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,” she said.

She added that because most phases of the procedure are conducted online, the process is also simple and hassle-free and allows women to start the process in the comfort of their home or in an environment that they’ve chosen themselves.

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