Academy statement: Telemedicine and early termination of pregnancy
The Council of the Academy of Medical Royal Colleges supports the permanent implementation of the telemedicine for early medical abortion (EMA) service and calls on the UK Government to continue provision indefinitely beyond 30 March 2022, alongside face-to-face appointments, so women seeking an early medical abortion can continue to access this vital healthcare service at home.
The telemedicine service, which has been recommended by NICE as best practice in abortion care, has proven to be a safe and effective way of allowing women to have more control and choice in accessing an early medical abortion. Women have also clearly indicated their support for the service to be a permanent option in their healthcare, with research published in the British Medical Journal showing that 89% of women who used a telemedicine service would choose to have treatment at home again if they needed another abortion, with 71% opting for a telephone consultation in the future. An additional study of entirely remote telemedicine abortion services published in the British Medical Journal found that 83% would not have preferred to see a doctor or nurse in person for the current abortion and 66% reported a preference for a future telemedicine EMA if there were no COVID-19 restrictions.
Studies into the implementation of early medical abortion service via telemedicine have found the service to be an effective way of giving medical care to women. Evidence shows the service has increased the safety of abortion services as women have been able to access an abortion much earlier in their pregnancy, with 40% of abortions provided at less than six weeks, and waiting times for abortion treatment improved from 10.7 days to 6.5 days. The telemedicine service can also provide a more accessible care pathway for women in vulnerable situations such as abusive relationships, as they don’t have to physically travel to a clinic.
Safeguarding of women and girls who are seeking to access an abortion is of paramount importance to healthcare providers. The RCOG will work with child health and safeguarding organisations on quality standards to ensure that women and girls who are seeking to access an abortion can do so safely and legally. This will require a greater proportion of young women and girls to attend face to face appointments for safety reasons. We are discussing what further steps can be taken to ensure that the provision of services remains as safe as possible for all women and girls, including ensuring that all information is up-to-date and that abortion providers are clearly communicating the limits for when abortion pills should be taken and that it is illegal for someone to access pills for an early medical abortion and then share these with someone else.
Telemedicine care for EMA has been one of the few success stories of the pandemic, where barriers have been removed to allow women to access an essential form of healthcare. Failure to renew this service will lead to longer waiting times for women and added unnecessary pressure on healthcare providers. The Academy Council supports the continued provision indefinitely of the telemedicine service for early medical abortion, alongside face-to- face appointments.
Background
In March 2020, as a result of COVID-19, the UK Government changed abortion regulations to allow telemedical EMA temporarily in England. Data published by the Department of Health and Social Care found taking both medications for an EMA at home had become the most common abortion care procedure – accounting for 47% of all abortions during the period April to December 2020.
There is overwhelming evidence that telemedicine for EMA has created a safer and more effective service. Over 100,000 women in England and Wales have now had an early medical abortion at home and data shows that complications related to abortion, which are already rare, have actually decreased since this service was introduced. A study of more than 50,000 abortions before and after the change in England and Wales, published by the British Journal of Obstetrics and Gynaecology in February 2021, concluded that telemedical abortion provision is ‘effective, safe, acceptable, and improves access to care’.
Furthermore, waiting times for abortion care have also reduced and women have been able to receive care much earlier in their pregnancy, with 40% of abortions provided at less than six weeks, and waiting times for abortion treatment improved from 10.7 days to 6.5 days.
Research published by the British Medical Journal looking at women’s experiences of using telemedicine has shown that 83% of women who have used a remote consultation for EMA found it ‘very acceptable’ and 89% said that they would opt to have treatment at home again if they needed another abortion, with 71% opting for a telephone consultation in the future.
Allowing the home use of abortion pills improves access to care, especially for vulnerable women. Many women face barriers in attending face-to-face services, for example due to lack of transport arrangements, disability, child-care responsibilities, or abusive relationships. Remote access to abortion services in England is vital in ensuring that these women can access care. NICE guidance on abortion care pre-pandemic recommends ‘providing abortion assessments by phone or video call, for women who prefer this.’
Furthermore, providers of abortion services continue to face significant pressures due to precautions and staff absences caused by the pandemic, and have been clear with the UK Government that they will not be able to provide women with timely access to an abortion if the telemedicine service is removed. This will likely lead to increased levels of late term abortions and risk women being forced to access illegal methods of abortion if they are unable to access legal services.
Telemedicine care for EMA has been one of the few success stories of the pandemic, where barriers have been removed to allow women to access an essential form of healthcare.
30 March 2022
