UT study: Banned internet-supervised abortions are safe


Study of Irish women finds supervised self-administered abortions are as safe as if performed in a clinic.

Study’s lead author says situation of Irish women similar to those of women in Texas.

State law prohibits the use of telemedicine for abortions.

University of Texas research into abortion has yielded a conclusion in stark contrast to state law: Abortions properly supervised over the internet are safe for women.

In Ireland and Northern Ireland, where abortion is a criminal offense in most cases, women are increasingly turning to organizations such as Women on Web, a nonprofit that provides abortion-inducing medicines and remote real-time instruction on their use, said Abigail Aiken, an assistant professor at the LBJ School of Public Affairs and the lead author of a report on research into abortions via telemedicine.

The online program is as safe for women as doctor-supervised visits and is safer than carrying a child to birth, according to peer-reviewed findings that were published this month in the academic journal The BMJ (formerly called the British Medical Journal).

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The results suggest that, when proper supervision is available, telemedicine could be a safe approach for women in areas where abortion access is restricted — including much of Texas, particularly its rural parts — Aiken said.

“The parallels between women seeking abortion in the U.S. and Ireland and Northern Ireland are striking,” Aiken said. “For many women throughout the South, Appalachia and the Midwest, where state laws have forced clinics to close … self-sourced abortions can be safe as long as they’re run through a sound model.”

Abortion via telemedicine is banned in Texas. That ban is one of eight general types of Texas abortion laws “that are not grounded in science,” according to a study by the abortion rights group, Guttmacher Institute. The institute’s study found that Texas was tied with Kansas for most abortion laws that flout science.

In this legislative session, many of about two-dozen bills to tighten abortion regulations have stalled and none has been sent to Gov. Greg Abbott. The session adjourns May 29.

Potential legislation would require more rigorous reporting of medical complications related to an abortion and a ban on medical research on fetal tissue from abortions.

Aiken chose to study abortion in Ireland partly because unlike, say, parts of Africa, with vast distances and different cultural mores, women seeking abortions in Ireland and Northern Ireland face many of the same choices as women in the American South.

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Aiken and Princeton University researcher James Trussell over three years studied 1,000 women who sought an abortion through Women on Web. They reported that 95 percent of the women in the study reported successfully ending their pregnancy.

Nearly all were less than nine weeks pregnant at the time they filled out the online consultation form. The researchers found that less than 10 percent reported symptoms of a potentially serious complication, such as fever or heavy bleeding. Less than 3 percent reported treatment for an actual complication, which is comparable to the rates for women who seek medical abortions at clinics where abortion is legal. Seven women needed a blood transfusion at a clinic; another 26 received antibiotics.

No deaths were reported.

Follow-up information was missing for 29 percent of the 1,636 women who were sent pills over three years, so some complications may have been missed.

Aiken emphasized that her research pertained to a nonprofit that provided both the drugs available in a clinic and advice in their use. Her research does not address the debate over the morality of abortions, such as whether life begins at conception or birth or somewhere in between, and the implications that stem from a person’s assessment.

The research relied on self-reporting from the women who sought an abortion, a potential limitation in assessing the program’s effectiveness. Aiken said studying self-reported data is the only option available under the circumstances. Because the women are already operating outside a traditional health care setting, they are under no obligation to report anything but what they volunteer. But because they face health risks if they do not fully disclose their medical history, “they have no incentive not to accurately self-report.”

Complication rates related to abortions were part of the arguments used to debate regulations passed in 2013 that closed several abortion clinics across the state. Lawyers for Texas argued that the rules were needed to protect the health and safety of women seeking an abortion. Opponents said the regulations imposed an unconstitutional burden on access to abortions, a relatively safe procedure, and argued that the complication rate is 0.2 percent or lower.

The U.S. Supreme Court in June struck down the regulations, which required hospital-like settings for all abortions and for doctors to gain admitting privileges in nearby hospitals.

Since then, at least three Texas abortion facilities have reopened or are about to reopen.

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