July 2017

Women who have acquired medical abortion pills through an online telemedicine service report successful abortions with low rates of adverse effects. Our study examined outcomes of a large sample of women in Ireland and Northern Ireland who used this service, which offers telemedicine consultation with a physician and, if indicated and appropriate, prescription and postal delivery of the abortion medication. The findings have potentially far-reaching implications.

We examined self-reported outcomes following medical abortions conducted through Women on Web (WoW), a nonprofit digital community that provides online access to medications used to induce abortion. The population-based analysis of 1,000 women in the Republic of Ireland and Northern Ireland who self-sourced medical abortion during a 3-year period examined self-reported outcomes and complications and assessed women’s ability to self-screen for the symptoms of potentially serious complications and their likelihood of seeking medical attention if complications do arise.

Almost 95% of respondents reported that they successfully ended their pregnancy without the need for surgical intervention. Seven women (0.7%) reported receiving a blood transfusion, and 26 (2.6%) reported receiving antibiotics (route of administration [IV or oral] could not be determined).  No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety-three women (9.3%) reported experiencing any symptom for which they were advised to seek medical attention and, of these, 87 (95%) sought attention. None of the 5 women who did not seek medical attention reported experiencing an adverse outcome.

We acknowledge the limitations of self-reporting, but we also emphasize that in situations where women self-source their own abortions outside the formal healthcare setting, self-report is the only possible method of follow-up. The strengths of the study include the large sample size and high follow-up rate, which are comparable with or, in some cases, better than studies of abortion within the formal healthcare setting.

Abortion laws in Ireland and Northern Ireland are among the most restrictive in the world, with abortion criminalized in most circumstances. However, online telemedicine has dramatically changed abortion access. Irish and Northern Irish people who access or help others to access this pathway are choosing an option that has similar effectiveness rates to medication abortion performed in a clinic and has lower rates of complications than continuing a pregnancy to delivery.  Our study shows that medication abortion self-sourced and self-managed outside the formal healthcare setting can be a safe and effective option for those who rely on or prefer it.

The findings also have implications for other parts of the world where abortion is difficult to access. Women in Ireland and Northern Ireland have three options when faced with a pregnancy they do not want or feel they cannot continue: travel long distances to access in-clinic abortion care, remain pregnant, or self-source their own abortion outside the formal healthcare setting. Safe, supported, and effective at-home medication abortion could be an option for women facing similar or more severe restrictions in other nations. In the United States, following waves of restrictive legislation, state laws have forced clinics to close throughout the South, Appalachia, and the Mid-West regions. For these U.S. women, the parallels with our Irish study subjects appear striking.

The full study published in the BMJ with coauthors Irena Digol and Rebecca Gomperts is Open Access and available at no cost: http://www.bmj.com/content/357/bmj.j2011 .

—Abigail R.A. Aiken, LBJ School of Public Affairs, University of Texas at Austin and James Trussell, Office of Population Research, Princeton University