Why do we need to see a
doctor to swallow a pill?
Recent articles in the New
York Times have focused on women self-inducing abortion using misoprostol.
The safe use of medication abortion by women raises the larger issue
of how the approved use of mifepristone/misoprostol now available at
many clinics could be simplified to increase women’s access to abortion
in the U.S.
In 1988 mifepristone/misoprostol
for abortion before 9 weeks was approved in France and China, and by
2002 was approved in 29 additional countries. This combination of medications
allows women to induce a miscarriage rather than have a suction procedure
with a physician (Nine more countries approved the drugs for early
abortion between 2002 and 2008). The promise of medical abortion
was increased access for women, because there would be less need for
a physician who had the hard-to-obtain training in suction abortion.
However, in most countries women are required to visit a clinic or doctor’s
office to take the first dose of the medication regimen, and return
for a follow up visit to confirm that the abortion was complete.
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As early as 2002, well-respected
researchers were questioning the over-medicalization of the procedure,
citing evidence that most women can safely and effectively handle the
medical abortion process themselves, effectively and safely.
In countries with legal access to abortion, these researchers speculated
that putting the medication into women’s hands would allow greater
control, comfort, and convenience as well as a lower over-all cost for
Since 2006, Women on Web (WoW)
has put this theory into action. Through an Internet helpline
which is staffed 18 hours a day, seven days a week, in six languages,
WoW arranges for women to complete an online consultation which is reviewed
by a physician. If there are no counterindications and the woman
is within the gestational age that a medication abortion can be effective,
the physician arranges with a consultant to ship 200 mg. of mifepristone
and 600 mcg of misoprostol. Throughout the abortion process, women
have Internet access to skilled counselors to answer any questions or
concerns, medical or emotional, that arise before, during or after the
WoW collects evaluations from
women who use the service, and the results have been overwhelmingly
positive. This is remarkable evidence of the safety of home use of medication
abortion, as many of the women who contact WoW have low literacy rates
and/or are communicating in a language that is not their native tongue.
Women from over 100 countries where there is no access to safe abortion
have successfully used the service to end an unwanted pregnancy, and
have expressed great satisfaction with the results and gratitude at
being able to safely take control of their reproductive lives, guided
by internet support.
In many countries, the battle
for safe abortion started with women empowering themselves by learning
about medicine and creating self-help groups. Women in countries
where abortion is legal have something to learn from women who have
used WoW – medication abortion is a safe, straightforward option for
ending an early unwanted pregnancy, and could be made more available
and less expensive if home use were an option.