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Self-managed abortion is a safe, effective option amid COVID-19, Stanford researchers say

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This article is part of a series highlighting recent research on reproductive health for National Women’s Health Week, which begins on Mother’s Day each year. 

The ongoing coronavirus pandemic has upended the world. As of Wednesday, almost 300,000 people have died. Stay-at-home orders continue to restrict movement, and the world economy is suffering

In this new climate, a debate has arisen around reproductive healthcare, and whether or not it should be considered an “essential service.” A group of Stanford doctors argue that self-managed abortion, or the “abortion pill,” is an essential service — and safe and effective — in the era of COVID-19. 

Some states have used this crisis as an opportunity to restrict access to reproductive healthcare. 

As many states have moved to halt nonessential surgical procedures, lawmakers in six states have attempted to classify abortion as “nonessential” and ban it indefinitely. In March, healthcare providers in four states filed lawsuits to prevent these orders from taking effect. Injunctions ensuring clinics could stay open were granted in Texas, Ohio and Alabama. In Texas, though, a federal judge quickly overturned the injunction, spawning a legal battle that has escalated to the Supreme Court. 

In Pennsylvania, a bill to expand access to telemedicine was vetoed by Gov. Tom Wolf. The governor says he rejected the bill because it specifically stated that telemedicine could not be used to access medications for abortion care.

“Abortion laws have never been more restrictive,” wrote Erica Cahill M.S. ’19, clinical assistant professor of obstetrics and gynecology and complex family planning, in an email to The Daily.

Excluding miscarriages, 1 in 5 pregnancies end in abortion, but 90% of U.S. counties lack abortion providers. 

Cahill and Jennifer Conti M.S. ’16, a medical journalist and affiliated clinical assistant professor in the School of Medicine, described medication as a safe and effective way to terminate a pregnancy up to 70 days’ gestation, in a review article published late last year in Current Opinion in Obstetrics and Gynecology. 

While the article was written prior to the outbreak of the COVID-19 pandemic in America, Cahill says “it is even more relevant today.”

Despite the fears of almost half of abortion providers, who raise concerns with “inappropriate self-selection for medication abortion” and “underestimating gestational age,” the article cites research proving that most women are in tune with their cycle and can accurately estimate their gestational age within a few weeks.

“Abortion care in a clinical setting is incredibly safe,” Cahill wrote. “Medication abortion is incredibly safe.”

“We wanted to review the data on … the safety of managing an abortion through medication outside of a clinical setting, the outcomes, as well as the complicated politics,” she added. “The safety has not changed, but the politics [have] just become more complicated.”

Cahill and Conti also host “The V Word,” a podcast covering reproductive health.

Abortion in the age of COVID-19

Cahill said that, due to state and federal restrictions, many clinics throughout the country are now operating under limited schedules and staff. And while telemedicine has expanded rapidly, it has not been expanding “as rapidly as it could be,” she wrote. 

COVID-19 has accelerated the use of telemedicine, which can be a useful option for women who live in the 33 states that require a physician to supervise medication abortions, or women who live in so-called “abortion deserts,” cities where people have to travel over 100 miles to reach an abortion facility. 

“When you consider all the people that really have to travel long distances in order to get an abortion in some states,” said Paul Blumenthal, chief of the Stanford Gynecology Service and editor the review article, “given that we’re very confident it’s safe, then why shouldn’t they be able to access this kind of healthcare?”

“Many people decide they need an abortion,” Cahill wrote. “1 in 4 women has had an abortion by age 40.” 

“This means 1 in 4 male partners have participated in a pregnancy that has ended in abortion by age 40,” she added, though this is an estimate.

Most doctors approve of the telemedicine model, with the majority agreeing that it would be appropriate to mail abortion medication after an online or phone screening, according to the article. 

“We are already seeing an increase in clinic patients seeking medication abortion compared to in-clinic abortion,” Cahill wrote. 

Confronting misinformation 

Misinformation regarding abortion was rampant even before the outbreak of the pandemic. 

After analyzing Google search data in 2015, The New York Times reported that there were about 700,000 searches for ways to induce an abortion outside of a clinical setting.

Almost a quarter of these searches were specific to purchasing abortion pills online. Another quarter were related to herbal methods, thought to end pregnancy despite no scientific evidence.

“Disconcertingly,” the review article states, there were “over 4000 searches for directions on using a coat hanger to abort a pregnancy.”

Cahill connects the search for ineffective or unsafe abortion methods to restriction on access to safe abortion. 

“The anti-abortion politicians in many states have used the COVID-SARS crisis to further block access to reproductive health, specifically abortion — forcing even more people to search for options outside of clinical care,” Cahill wrote. 

The analysis also showed “an increased prevalence of searches for self-managed abortion in areas with more restrictive abortion policy,” the article states. 

Cahill said that if there are barriers to seeking a clinical abortion, people will seek abortion outside of a clinical setting. She said health care providers can ensure access to safe abortion by knowing where to refer patients, such as the National Abortion Federation hotline

Cahill also said that people can let their representatives know that abortion care is essential and time-sensitive. 

“We can never outlaw abortion, only safe abortion care,” she wrote.  

Because so many women seek information about self-managed abortions online, Cahill and Conti argue, it’s critical that search results reflect accurate information on the safety and efficacy of these medications, as well as the potential legal concerns. 

Cahill said patients must “have access to accurate information and confidential backup medical care in the event it’s needed.” She said that people who have self-managed an abortion, and then decided to seek clinical care, have no obligation to disclose this abortion to medical providers, and that medical providers have no obligation to report patients to the police for having a self-managed abortion.  

“In fact,” she wrote, “medical providers may violate state and federal medical privacy laws if they do so.”

“I think that some place, somewhere, somehow, a certain number of women will always gravitate towards the option of a self-managed abortion,” Blumenthal said. “And some women won’t. But that’s what we’re really trying to provide … options and access.”

Stanford students can access clinic-based abortion medication at the Stanford Gynecology Clinic. 

Contact Emma Talley at emmat332 ‘at’ stanford.edu.

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