Online clinic could be alternative abortion service, study suggests

By Michael McHugh

An online abortion service can offer an alternative to unsafe methods of ending pregnancies, a study of women in Northern Ireland and the Republic concluded.

Almost 95% of interventions were "successful". A tenth sought medical attention.

International researchers analysed data showing that rates of adverse effects after using drugs to induce terminations early were low.

The countries have some of the most restrictive abortion laws in the world.

A study published in the British Medical Journal (BMJ) said: "For the millions of women worldwide living in areas where access to abortion is restricted, the findings show the vital role played by self sourced medical abortion in providing an option with high effectiveness rates and few reported adverse outcomes."

In Ireland, since 2014, a pregnancy can be terminated under the Protection Of Life During Pregnancy Act if there is a risk to a woman's life, including from suicide.

The procedure can involve a medical or surgical termination or an early delivery by induction or Caesarean section to deliver the baby.

But there are growing campaigns for women to be allowed access to abortion if their unborn child is diagnosed with a fatal foetal abnormality or in cases of rape and incest.

In Northern Ireland abortion is legal only if a mother's life is at risk.

The majority of women have to travel to England or another country to access the service.

Researchers from the University of Texas analysed self-reported outcome data submitted to a telemedicine clinic by 1,000 women four weeks after receiving and using the drugs mifepristone and misoprostol to end an early pregnancy.

The findings showed that rates of adverse events were low and women were able to identify potentially serious complications and seek medical attention when advised.

The academics said: "The results provide the best real-world evidence to date about the effectiveness and harms of self-sourced medical abortion through telemedicine in a population of women who otherwise do not have reliable access to abortion services."

Ninety-two women (9.2%) reported experiencing any symptom for which they were advised to seek medical attention and, of these 87 (95%) sought attention.

None of the five women who did not seek medical attention reported experiencing an adverse outcome.

In a linked editorial, researchers in Canada said while findings from self-reported data must always be treated with some degree of caution, these "reassuring study data support growing calls for reform".

They said repeal of legal restrictions would support the safest and most equitable abortion care for women in Irish jurisdictions.

"Until then, for the first time in history, women of all social classes in a legally restricted yet high resource setting have equitable access to a reasonable alternative: medical abortion guided by physicians through telemedicine."

Clare Murphy, director of external affairs at the British Pregnancy Advisory Service (bpas), said the study shows medical abortion with online support can be performed safely and successfully at home.

"Organisations like Women on Web supply the same safe, high-quality medications that women would receive if they came to bpas.

"The greatest risk women face when using online pills in this way is not a medical one, but a legal one. In recent years we have seen women in Northern Ireland dragged before the courts for using online pills because they have no access to a lawful service at home.

"Illegal abortion carries the threat of life imprisonment for women. However safe and effective online services can be for women in countries where abortion is illegal, ultimately what women need is a legal, local service."