In countries where abortion is illegal, a group called Women on Web is offering medical abortion over the Internet. (via National Women’s Health Report)
Clients complete an online questionnaire and are then contacted by a doctor who prescribes the medications that are then taken at home to induce abortion. The medications are mifepristone (RU-486) and buccal Misoprostol. (Buccal is holding the medication in your cheek till it dissolves.) The vaginal route for misoprostol is avoided so that no evidence of pills is left to implicate a user.
The group has published outcomes on 484 women from 33 different countries who received their services in 2006-7. Follow up was obtained via e-mail or phone for 367 women.
About 8% of the women never took the medication. For those who did, outcomes were reasonable for the method used – Between 6 and 12% reported having to have a D&C for bleeding or incomplete abortion, which presents as an early miscarriage and can be treated safely in a medical setting. Continuing pregnancy rates were less than 2%.
These results are similar to those reported in the initial clinical trials of mifepristone here in the US.
The Royal College of Obstetricians & Gynecologists has released a statement saying that it “neither approves or disapproves” of the work provided by Women on the Web. More from that statement –
The results from the study demonstrate that Early Medical Abortion is safe and acceptable to women, confirming other studies including the recent pilot study conducted by the Department of Health in May. The study also shows that women are capable of safe self-administration of drugs provided they receive good and clear instructions, are aware of the possible side-effects and the nature of complications which indicate that further medical attention is required.
And more from the BBC on the UK reaction.
What are the legal issues?
Women on the Web claims its services are legal, even in those countries where abortion is not, since the receipt of medications for home use does not violate customs laws. They do not offer the service in countries where abortion is legal.
The Women on the Web Site
I went to the site, and have to say that I am quite impressed with the quality of the service.
Women are told to go have an ultrasound if it is available to confirm their gestational age before using the service. (Ultimately 80% do so, an impressive percentage) For women where ultrasound is not available, instructions are given to determine gestational age, which prior research has shown to be accurate in most cases.
All cases are reviewed by a doctor for contraindications before medication is released. (I wish they had reported how many women were refused medication for medical reasons or referred elsewhere so I could get a handle on this aspect of the care.) Women are told to seek care for complications in a medical setting. Warnings about undiagnosed ectopic pregnancy, probably the most serious risk of this procedure, are clear and frequent.
The site uses idealized data from other clinical trials in their information about complications. (Now that they have their own data on outcomes, I would urge the group to use that info to guide women in their decision as to whether or not they wish to use this service.)
The site also asks women to post a photo and /or their experience on the site, in an attempt to remove the shame surrounding the procedure. For women who don’t want to use their own photo, the generic photo up there is used. The photo is a sexy, braless blonde in a mini dress. …what’s that about?
How do I feel about this?
Uncomfortable is probably the operative word. I like to see medicine practiced face to face whenever possible. Plus, I’m a law abiding citizen, whether I like the law or not.
But I know that I feel this way because I practice medicine in a country where abortion is safe and legal (for now, at least). If I were practicing in one of the countries where abortion is illegal, and seeing the consequences of those laws in the lives and health of my patients, I might feel very differently. As a physician, I’d probably prefer to handle the miscarriages that result from an early Internet-based medical abortion over the complications from a botched curettage.
I feel like you do about this topic. Well put post.
Well done. I read about this and it is certainly a good alternative for women who are in countries that do not allow abortion. I remember the days BEFORE Roe vs. Wade and hope we never go back.
Ditto what Ramona said.
It’s difficult in some parts of the country to get a medical abortion; too bad they probably don’t send stuff to the US. It can be easy to forget that women don’t have access to clinics in most counties.
Well written post about a typically divisive topic.
TBTAM,
Would this be a very good example of DTC advertising? An interesting twist to that argument.
While this liberates women who are otherwise oppressed, I can’t help but feel that the use of meds for spontaneous abortion is realy risky. The data that you listed highlights the same.
Question for you…if these women who have few options use the drug and have complications, do they then have to face social and legal penalties or would the use of the drug never really be apparent or important for the treating physician to know? Scary to think that a web site who claims legality could get a woman into serious trouble.
Last point is on the advert itself. Is the message that even beautiful, affluent women get abortions, and you can be one too? To me, that was the message screaming out from the page – and that to me is the scary part.
Schrugglin-
Agree – that photos struck me as realy odd.
Because the pills are taken at home and the failed procedures present as a msicarriage, there is no evidence to implicate anyone.
Clients are told they are responsible for getting their meds through customs. Appartently, meds through customs is not an issue in most of the countries served.
I got this info from the website, am making the assumption that it is correct. No guarantees, of course.
Tank you for posting this. I agree with your reservations, and you phrased them so well. I would rather treat women who had a complicated medical abortion than a botched illegal curettage.
I love it when people look at the controversy practically, and you did a wonderful job of doing that. You considered the realities of the women and the practitioners and the available medical information.
This was a great post. It’s good to know something like this is out there for those who don’t have access to clinics.
Very well said. Even though I can’t speak from personal experience, I like to think that access to contraception and abortions is easy here – as opposed to other countries, so the use of this service seems unnecessary here. But if I lived elsewhere? I might feel different. It’s scary, taking one’s health into one’s hands like that, even with the consent/review of a “doctor.” I can’t imagine if things went wrong, if the woman would be able to get the needed help.
In a perfect world, back alley abortions and those self-induced would be a thing of legend and lore. I wish it were different.