Cape Town - With half of all South Africa’s abortions estimated to be performed by unlicensed providers, researchers are calling for telemedicine abortion to be prioritised, in which most parts of the process would be conducted online.
Scientists drew these and other conclusions after completing the world’s first randomised control trial (RCT) into the efficacy 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, a research-led medical university 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 was an essential part of a woman’s reproductive rights.
Abortion care consists of several fundamental components: counselling and providing the necessary information the patient needs; screening for eligibility, which includes an assessment on the duration of the pregnancy; providing a set of clear guidelines on how to perform the abortion at home; issuing the medication and conducting a follow-up examination post-procedure in a clinic.
Because some of these components can 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.
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 participants (450) were randomly selected for the standard care option and received an in-person consultation with a health-care worker (HCW).
The HCW performed an ultrasound to assess the stage of the pregnancy and later facilitated the abortion in the clinic.
The remainder of participants were selected to participate in the telemedicine abortion model intervention.
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.
She added that most women who participated in the research study reported that they preferred the telemedicine model of care for abortions.
Cape Times