Study Shows that Screening for Medication Abortion Using Medical History Alone is Effective and Safe

A study published this month in JAMA Internal Medicine provides evidence to show that screening for medication abortion based on medical history alone is highly effective and low risk, with medications dispensed either in-person or by mail.

To date, screening for medication abortion eligibility usually includes ultrasound or pelvic exam, which can be expensive and require an in-person visit to a facility with trained personnel and appropriate equipment. For many, this in-person visit is a significant barrier to access. The onset of the COVID-19 pandemic created greater openness to re-evaluate routine use of facility-based pre-abortion screening tests.

This study by ANSIRH, Gynuity Health Projects and others included nearly 3,800 people in the U.S. who between February 2020 and January 2021 obtained from 14 facilities that offer in-person and online abortion care a medication abortion using medical history alone.

The study found that 95% of eligible abortions were complete without additional medical intervention. This rate is comparable to studies of medication abortion models with screening ultrasound (93% to 98%). The major adverse event rate of 0.5% was slightly higher than previous studies (0.2% to 0.3%) but not significantly different and still rare from a clinical perspective. There were similarly high effectiveness and safety rates when comparing medications dispensed in-person and by mail.

The findings from this original investigation are reassuring, as we expect that remote abortion care will become an increasingly critical component of future efforts to maintain access to abortion.

The high effectiveness and safety rates show that mandatory ultrasound laws are not rooted in scientific evidence and are medically unnecessary when it comes to medication abortion. Use of history-based screening may facilitate more equitable access to abortion care and appeal to primary care providers and others without access to ultrasound technology.

Upadhyay UD, Raymond EG, Koenig LR, et al. Outcomes and Safety of History-Based Screening for Medication Abortion: A Retrospective Multicenter Cohort Study. JAMA Intern Med. Published online March 21, 2022. doi:10.1001/jamainternmed.2022.0217