The Risks of Telemedicine Abortion

Telemedicine abortion—often by phone—is on the rise 

During the COVID-19 pandemic, a minority of counties allowed abortion providers to send abortion pills (usually mifepristone and misoprostol) to women by mail after a remote video or phone consultation, with no in-person contact throughout the process, Calum Miller points out in Chapter 16 of Agency, Pregnancy, and Persons. This is called telemedicine abortion, and concerns have been raised publicly about it in an open letter from over 600 health-care professionals.  

Please note: 

• Miller presents research studies from the UK regarding these concerns. However, note that the same dangers of telemedicine abortion are present in the U.S. and were published by Dr. Ingrid Skop of San Antonio, TX, citing U.S. studies. 
• Miller tells us that, though telemedicine can include phone or video consultations, a client survey found that, of 85 phone calls to a variety of telemedicine abortion clinics, not a single provider suggested a video call. 

In-person consultations help identify victims 

Unwanted pregnancy can be a warning sign of domestic abuse or trafficking. Contact with health-care staff is a unique opportunity for victims to be identified. Without an in-person consultation, a visible assessment that might identify victims of abuse cannot take place.  

But concern about telemedicine abortion doesn’t end there. Miller outlines several other concerns stemming from no assurance the patient is alone and therefore speaking to the provider confidentially, no background relationship with the patient, no access to medical notes, and no in-person screenings. 

A growing risk of coercion 

The first of these serious concerns is that 20-25% of abortions are coerced by male partners (an estimate calculated by averaging typical numbers with the numbers of abuse and trafficking victims). Central reassurance offered by abortion providers has been that women will be seen alone to assess for any coercion they may be feeling. Telemedicine comes with no assurance that the woman is alone and speaking confidentially. This is a serious problem, because coerced abortion is held by all parties to be a brutal form of discrimination and carries a large risk of mental health difficulties following abortion. 

This is particularly concerning since, even in person, abortion providers themselves have been found guilty of pressuring to abort, an action for which staff are awarded (page 27), according to the regulator reports of MSI, one of the largest abortion providers in the UK. Miller explains that failures against safeguarding found among BPAS and MSI, the two biggest abortion providers included failure to obtain legitimate consent from vulnerable patients such as children, those with disabilities, and those with mental health difficulties; pressure to abort, as mentioned; and repeated failure to escalate safeguarding concerns to local authorities. The risk of coercion by abortion providers, claims Miller, is therefore only amplified by the widespread unobserved phone or video calls of telemedicine. 

Abortion minus an exam 

Telemedicine abortion carries serious safety concerns, Miller continues. Formerly, the standard practice was examination and ultrasound prior to abortion; in fact, these are mandated by the WHOs safe abortion guidance from 2012. Physical exams confirm pregnancy, verify gestational age, and indicate possible ectopic pregnancy, multiple pregnancies, fibroids, pelvic tumors, and molar pregnancies (WHO 2012, p. 35). 

Telemedicine abortions occurring too late 

Women often do not accurately recall their last period. Furthermore, abortion providers have been found sending pills to clients that could arrive after the 10-week limit for medication abortion, and women may not take the pill as soon as it is received.  

The risks of complications like hemorrhage, infection, incomplete abortion, and ongoing pregnancy increase exponentially with gestational age (Bartlett et al. 2004; Endler et al. 2019). Women having a telemedicine abortion after 9 weeks are also at risk of Rhesis disease.  

Ectopic pregnancies going undetected 

Ectopic pregnancies are more difficult to diagnose during and after abortions due to similarity of symptoms. Bleeding after medical abortion typically lasts two weeks, and sometimes longer, masking ectopic symptoms for a significant period of time. A study by Aiken et al. found that ectopic pregnancies detected after the abortion were three times more common with telemedicine.   

Incomplete abortions, hospital visits, surgeries, and antibiotics  

The Care Quality Commission was notified of 13 fetuses delivered past 20 weeks’ gestation at home with no medical supervision after women took abortion pills. Along these lines, abortion providers were recently found to fail to report incomplete abortions.  In the UK, reporting failures of complications and ambulance calls relating to medical abortion increased dramatically following the introduction of at-home medication abortion and then full telemedicine. Even in studies of telemedicine abortion that included some in-person components, 8% of women ended up attending a hospital, emergency department, or urgent care center.  A systematic review of telemedicine found that, even with mandatory ultrasounds, when all gestations were included, surgery rates varied from 8.5 to 20.9% and the need for antibiotics was 9.3%. 

Miller concludes that concerns about telemedicine are serious, and recent studies only raise more concern about the practice.  

The FDA is particularly alarmed by the dangers of “advance provision,” selling abortion drugs to women who aren’t even pregnant.

[Photo credit: Edward Jenner on Pexels]