Eleven states require ultrasounds for every woman seeking an abortion. Photo by Aleksandr Khakimullin/Shutterstock
Women can safely use abortion pills without first having an ultrasound or an in-person medical appointment, a new study confirms.
For more than 20 years, American women have had access to medical abortions to end early pregnancies, using the drugs mifepristone and misoprostol. But for most of that time, the US Food and Drug Administration required them to have an in-person appointment to get a prescription.
Meanwhile, many states have imposed their own restrictions, including requiring women to have ultrasounds before you can get a prescription.
This is despite evidence from studies in several countries that medical abortion is effective and safe without such testing, according to Dr. Jennifer Karlin, a primary care physician at the University of California, Davis.
“Unfortunately,” Karlin said, “we have a lot of political decision-making around abortion care.”
Then came the COVID-19 pandemic. This prompted the FDA to temporarily lift the in-person visitation requirement, allowing women to book virtual “telemedicine” appointments and obtain abortion pills by mail.
Last December, the agency made this change permanent.
The new study – published online Monday in JAMA internal medicine – offers more support for this move, the researchers said. It also adds to a body of evidence that ultrasound requirements are unnecessary.
“It makes the evidence even stronger,” said Karlin, who co-wrote an editorial published with the results.
The study looked at the records of nearly 3,800 American women who had medical abortions between February 2020 and January 2021. None had a prior ultrasound or pelvic exam, and about a third received their prescription during a virtual visit.
Overall, the study found that 0.5% of women had an “adverse event”, such as hospitalization for pain or excessive bleeding.
That’s similar to rates seen in previous studies of medical and surgical abortion, the researchers said. And there was no significant difference between women who had in-person or virtual visits.
A body of research over the years has demonstrated the safety of medical abortion, said Ushma Upadhyay, who led the new study.
“It’s extremely safe – safer than Viagra, Tylenol and other drugs that don’t have these restrictions,” said Upadhyay, an associate professor at the University of California, San Francisco.
And the restrictions remain, despite the FDA lifting the requirement in person. Nineteen states, Upadhyay said, prohibit virtual tours for medical abortion.
Meanwhile, 11 states require ultrasounds for every woman seeking an abortion, according to the Guttmacher Institute, a research organization committed to promoting sexual and reproductive health and rights.
Medical abortion is approved up to the 10th week of pregnancy. It has been argued that ultrasounds are necessary to determine the progress of a pregnancy and to detect ectopic pregnancies. Ectopic means that the fertilized egg is implanted outside the uterus and medical abortion is not effective in these cases.
But medical groups, including the American College of Obstetricians and Gynecologists, say routine ultrasounds aren’t necessary.
Ectopic pregnancy is rare, Upadhyay said, and women can be screened by asking about their risk factors and any potential symptoms of the condition.
Likewise, despite some claims to the contrary, women remember the date of their last menstrual period quite well, Upadhyay said.
In this study, four ectopic pregnancies were detected and treated after the women were prescribed abortion pills. And nine women (0.4%) were past the 10th week of pregnancy – six of whom needed surgery to complete the abortion.
Upadhyay said she hopes evidence like this will influence states that deny women access to virtual or test-free visits for medical abortion.
As it stands, Karlin said, women in those states “are not getting evidence-based medicine.”
But Karlin agreed that the accumulation of scientific evidence could change that. “Eventually,” she said, “there’s so much evidence that there’s a tipping point where people can’t keep fighting anymore.”
The FDA, meanwhile, has further restrictions on medical abortion: Health care providers and pharmacies must be certified to dispense pills. The pharmacy rule is new and it is unclear what the certification process will be, Upadhyay said.
But again, Karlin said, there is no evidence base for the requirement.
She emphasized that it was about giving women options. Some will want in-person care, others will prefer prescriptions by mail.
“We want to meet people where they are,” Karlin said. “It’s about making high-quality care available in the form they want.”
The nonprofit Plan C has more on medical abortion.
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