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‘Internet abortions’ may be safe option where procedure is restricted, study suggests

In the United States, the Food and Drug Administration approved the abortion pill Mifeprex (mifepristone) in September 2000. (Courtesy of Danco Laboratories)

Five years ago, the tragic case of a young woman in Ireland made headlines around the world. Savita Halappanavar had been 17 weeks pregnant when she entered a hospital in pain. Doctors told her miscarriage was "inevitable." But they also said she had to continue to carry the baby because of the country's abortion ban. Her condition deteriorated, and she died within a week of an infection.

Halappanavar's death sparked numerous protests, investigations and soul-searching. Ireland still is among the strictest countries in the world regarding abortion law. But a study published in the BMJ on Tuesday details how some women can get around the restrictions — through telemedicine.

Researchers looked at data from Women on Web (WoW), a nonprofit group that provides an online consultation service for women who live in countries where abortion is restricted. Its doctors review the information a woman gives about her pregnancy and provide prescriptions for medical-abortion pills such as mifepristone or misoprostol. A third-party company fills the prescription and sends the pills in the mail.

WoW specialists offer support during and after the abortion process. The service is available for up to 10 weeks' gestation.

The study sample involved 1,000 women in the Republic of Ireland, where Halappanavar lived, and in Northern Ireland, which has a similar position on abortion although the region is part of the United Kingdom. Between 2010 and 2012, nearly 95 percent of the women reported during follow-up contacts that they ended their pregnancy without surgical intervention.

The rate of complications was similar to that of women using the abortion pill with the help of doctors in traditional, face-to-face office settings in countries were abortion is less restricted, the study found. Still, there were some problems. Ninety-three women were referred for further treatment by local doctors because of more severe symptoms, seven needed a blood transfusion, and 26 had to get antibiotics.

Researcher Abigail Aiken of the University of Texas at Austin and her collaborators in several other countries concluded that “self sourced medical abortions using online telemedicine can be highly effective, and outcomes compare favorably” with clinical protocols.

In an editorial also published in the BMJ on Tuesday, Wendy Norman of the University of British Columbia and Bernard Dickens of the University of Toronto noted that the safety and efficacy of the abortion pill is already known. What the study shows, they said, is that women in Ireland or other places with good access to quality health care may be able to self-assess their symptoms and manage potential complications.

“[F]or 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,” they wrote.

The study had one major weakness, researchers acknowledged: About a third of the 1,636 women who initially reached out to WoW during the study period did not contact the service again. As such, Norman and Dickens said, the sample size may be too small to detect the true risk associated with the treatment, and the complication rates reported could be an underestimate.

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