The pandemic has shown us that it is time to change the way we get medical care, and basic medical care, including abortion, is always out of reach for too many people. When we look to the future of care, the science is clear: medical abortion care is safe and effective, and it is time to lift the restrictions on it. now, FDA actions New research shows that removing restrictions on medical abortion care may expand the opportunities for many people in need of care.Special issue of the magazine July 2021 contraception Focus on the restrictions on medical abortion and mifepristone, including its impact on safety and effectiveness, abortion opportunities, and the burden on patients and providers.
Mifepristone is affected by Risk assessment and mitigation strategies (REMS). The REMS program is rare and is suitable for drugs that have a very serious risk of side effects. Mifepristone REMS includes three “elements to ensure safe use”: Mifepristone must be dispensed from clinics, medical offices or hospitals (not retail pharmacies); providers must be registered as certified prescribers; in addition to standard knowledge In addition to the consent form, the patient must also sign the patient agreement. In short, these restrictions make people think that mifepristone is dangerous for patients and too complicated for healthcare providers.
A large amount of data collected during the first 20 years of use of mifepristone in the United States shows that it is Efficient and extremely safeBefore 2020, opponents of the relaxation of mifepristone regulations may argue that mifepristone is safe for the nearly 4 million people who have used it in the United States Because Provisions. However, experience during the COVID-19 pandemic shows that restriction is not the reason for the safety of mifepristone.
For most of the pandemic, the in-person dispensing requirement for mifepristone was removed to restrict face-to-face contact. This means that providers can email mifepristone to their patients after the telemedicine assessment. Patients received the counseling and care they needed, and health care providers collected the necessary information to determine whether mifepristone is an appropriate option, and they all avoided the risk of contracting COVID-19. This change provides an opportunity to study how the removal of this requirement affects or does not affect the safety and effectiveness of medical abortion care.
two article inside contraception The special issue describes medical abortion care provided through different protocols in the United States, including telemedicine visits and then mailing of medications; both found that these care modes are safe (less than 1% of patients have severe complications) and effective (approximately 95%) Of patients had a successful abortion without subsequent surgery). Research from the UK (52,142 patients in England and Wales with 663 patients in Scotland) Emphasizes that providing medical abortion care through telemedicine and mailing drugs is safe, effective and highly acceptable to patients. In summary, these recent studies reflect the findings of the pre-COVID-19 era and reinforce what we already know: Mifepristone is safe and effective, no matter how and where it is distributed.
Medically unnecessary restrictions can affect the ability of healthcare providers to provide medical abortion care.A sort of Polls It was found that 24% of obstetricians and gynecologists who currently do not provide medical abortion care would do so if the requirement for in-person dispensing was eliminated, which may more than double the number of providers in the Southeast and Midwest, where abortion visits are severely restricted. Many patients prefer to receive abortion care from primary care providers with whom they have long-term relationships, but REMS hinders this process.
Although medical abortion care is entirely within the scope of primary care, REMS fuels stigma and obstacles At the individual and institutional level. The logistical challenges raised by REMS (including the requirement to dispense in person) and the resistance of institutional decision-makers have led to Supplier barriers Bring unnecessary burdens to patients. Remove REMS Allowing pharmacies to dispense mifepristone can help normalize medical abortion care, promote the provision of primary care, and address differences in access to abortion.
The patient’s reason for choosing to have a telemedicine abortion by mailing medicine underscores why this option is important: the patient described the importance of privacy, protection from stigma, avoiding unnecessary contact (especially important during COVID), and travel.In an interview study with 45 patients Hawaii, 13% of people said that if there is no option for drugs sent by telemedicine, they will have to continue to get pregnant.The ability to obtain abortion care through telemedicine is extremely important to improve access: providers can Reaching geographically distant patients, A provider can Serving the entire state Patients do not need to spare time, child care and travel funds.
Every year since then Mifepristone was approved in 2000, The research documenting its safety and effectiveness continues to grow, and each study is strengthened and built on the last one. We have enough high-quality data to support the reconsideration of the regulatory approach to mifepristone and the removal of REMS.this way Won’t be a panacea Taking into account the complex abortion restrictions imposed by many states, access to abortion, but this is a necessary step to make medical abortion care scientifically. it’s time.
This is an opinion and analysis article; opinions expressed Author or author Not necessarily those Scientific american.