In the midst of the COVID-19 pandemic crisis, some reproductive health researchers are urging the federal government and the U.S. Food and Drug Administration to remove protections on abortion drugs through increasing access to telemedicine and allowing doctors to prescribe the abortion pill, Mifepristone, over a long distance. These restrictions, also known as risk evaluation and mitigation strategy (REMS) according to the FDA Office of Media Affairs, are necessary for the abortion pill, mifepristone, when used for medical termination of early pregnancy (before 10 weeks only) in order to ensure that the benefits of the drug outweigh its risks.
The U.S. Food and Drug Administration has not responded to this request and in fact, strongly warns buyers “ not to buy Mifeprex over the Internet because you will bypass important safeguards designed to protect the health of the mother and the health of others.”
Recent telemedicine programs of this nature involved an initial in-patient consultation, pregnancy test, lab work, and an ultrasound to determine the gestational age of embryo or fetus. The physician would then review the labs and medical history remotely and connect with the patient over telehealth. If eligible, the physician will prescribe the abortion pill, supervise the patient to administer the first pill, and then the patient would take the second pill without supervision. This is already unsafe and sets the patient up for potential complications related to self-administration and unfavorable outcomes from increased risks.
The COVID-19 telemedicine protocols for the abortion pill are a gross contrast to the former. Now, there is no in-patient consultation or examination. Instead, there is only an initial screening over the phone to determine eligibility to receive the abortion pill. Depending on geographic location, some providers only require the last menstrual period to confirm gestation (how far along she is in her pregnancy) and proceed to prescribe the abortion pill. The patient is set up to create a no-test pickup where she can quickly pick up the abortion pills in a brown paper bag and is sent on her way.
The truth is not only is self-managed abortion not safe, but it also eliminates the necessary in-person examinations and in-clinic pregnancy testing for accuracy, and instead, relies on at-home pregnancy tests not being interpreted by trained health care professionals. Diagnostics such as ultrasound are not performed to determine the viability of the pregnancy. Furthermore, there is no education for potential miscarriage and ectopic pregnancies advising patients to seek emergent medical attention if they develop severe abdominal or pelvic pain, lightheadedness, dizziness, blackouts, low blood pressure, the passage of tissue, and life-threatening hemorrhages.
To further complicate a highly potential, life-threatening crises with a self-managed abortion, the woman is not only facing an unplanned pregnancy, but she is also placed at a very high risk of becoming susceptible to COVID-19.
The abortion pill, Mifepristone, carries 4-5 more complications for infection, undiagnosed ectopic pregnancy, failure to abort (women can still remain pregnant when abortion pill fails), and bleeding which will ultimately lead to emergent surgical intervention. In addition, the abortion pill is an immunosuppressive drug that can increase the risks of decreasing the body’s ability to defend itself against many pathogens such as COVID-19.
If complications occur, the woman will have to be admitted to the emergency room, overloaded with patients experiencing symptoms, and testing positive for COVID-19. This puts the woman, who is already suffering complications from a medical abortion at risk of exposure to COVID-19. Furthermore, there is no transition of care between emergency staff and prescribing providers.
The abortion pill has 4-5 times the likelihood of complications of hemorrhage, which can last two weeks or more. With COVID-19, there is a shortage of blood supply alongside other resources. If a woman has a complication, this doesn’t just impact the unborn but can be life-threatening to the woman herself.
Under no circumstance is self-managed abortion safe. The good news is that even in a COVID-19 pandemic if you have an unplanned pregnancy, there are safe resources and options still available that are in full compliance to government-issued shelter in place and CDC guidelines.
At Turning Point Pregnancy Resource Center, we are closely monitoring COVID-19 carefully by following these guidelines to protect our patients and our staff. Please contact us by phone (858) 397-1970, text (858) 822-9335, or email email@example.com to speak with our medical staff. We may also have telehealth consultation appointments available.