Medication abortion can be dispensed without an ultrasound or physical exam, study finds
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A new study from the University of California, San Francisco found using a history-based screening, no-test approach to medication abortion care is safe and effective.
That means health care providers don’t need ultrasound technology or to conduct a pelvic exam.
A history-based screening approach can create more equitable access to abortion, increasing the type of clinicians and locations that offer abortion care.
Even more women could receive safe and effective prescriptions for medication abortion after a study found health care providers don’t need to perform an ultrasound or pelvic exam. Providers can safely lean on a patient’s medical history, eliminating the need for expensive equipment.
Researchers from the University of California, San Francisco studied about 3,700 patients with eligible abortions. Medications for abortions were provided without an ultrasound or pelvic exam, instead using a history-based screening, no-test approach to medication abortion care.
The results of the study showed overwhelmingly positive results, with a 95 percent effective rate for abortion medications dispensed in person and a 93 percent effective rate for those mailed. Only 12 abortions experienced an adverse event, and four were treated for ectopic pregnancies.
Medication abortion consists of two pills, known as mifepristone and misoprostol. The drugs in combination are used to end a pregnancy and were approved for use in the U.S. by the Food and Drug Administration (FDA) in 2000.
Once approved, medication abortion quickly become popular, with the Guttmacher Institute, an abortion rights advocacy and research group, finding it accounted for 54 percent of U.S. abortions in 2020.
Researchers explained that a history-based screening approach can create more equitable access to abortion, with the potential to increase the type of clinicians and locations that offer abortion care.
Traditionally, health care providers use an ultrasound to confirm a pregnancy and to confirm it is not ectopic, a condition where the pregnancy occurs outside the uterus. Ectopic pregnancies are considered life-threatening and require emergency treatment.
When health care providers use a history-based method when screening for abortion care, they need to take into consideration two factors. First is when a women’s last menstrual cycle was, confirming she is less than 11 weeks pregnant.
“What we learned through this study is that many people very accurately know the date of their last menstrual period. People keep calendars, there are so many apps today, so people are very reliable in terms of knowing their bodies and knowing how far along their pregnancy is,” said Ushma Upadhyay, associate professor at UC San Francisco and lead author of the study, to Changing America.
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The second factor providers need to consider is assessing a patient’s risk of ectopic pregnancy. Factors like if a patient has previously had an ectopic pregnancy, had pelvic inflammatory disease or currently has an IUD (intrauterine device) in place would make them ineligible for receiving medication abortion through a history-based screening.
The implications of Upadhyay’s study are far reaching as it establishes grounds for not needing specialized equipment to offer medication abortion to patients, with ultrasound machines not only costing thousands of dollars but also requiring specialized training. That’s significant, as Upadhyay explained, “it’s that time and training and having a person available to conduct the ultrasound is another barrier for providers.
“And for many it’s such a huge barrier that they won’t offer medication abortion due to that misconception that an ultrasound machine is needed,” said Upadhyay.
According to the Guttmacher Institute, there are currently 11 states that mandate an abortion provider perform an ultrasound on each person seeking an abortion. The institute also notes that routine ultrasounds are not considered medically necessary as a component of a first-trimester abortion, stating that “the requirements appear to be a veiled attempt to personify the fetus and dissuade an individual from obtaining an abortion.”
Dissuading people from seeking abortion has become a national trend, as a slew of states have introduced and passed legislation that restricts or bans abortion services, including medication abortion.
One such example is in South Dakota, where Gov. Krisit Noem (R) signed a bill that requires women to make three separate in-person visits to a doctor’s office to receive both doses of medication abortion, while also banning medical abortions through telemedicine.
Similar laws requiring a prescribing clinician to be in the physical presence of a patient exist in 19 other states, including Alabama, Arkansas, Arizona and more.
“All of the latest evidence shows that medication abortion is extremely safe, it is safer than Viagra, safer than Tylenol. I think that these laws that specifically target medication abortion are precisely because the science shows that they should be made much more accessible. They should be treated like any other medication,” said Upadhyay.
The current wave of anti-abortion legislation is being fueled by a landmark Supreme Court Case — Dobbs v. Jackson Women’s Health Organization, which was taken up last year.
The case directly challenges the court’s 1973 ruling on Roe v. Wade by calling into question a Mississippi law that bans abortions after 15 weeks of pregnancy. The justices have already heard oral arguments on the case and are expected to issue their ruling before the end of the court’s term in June.
Given the conservative majority on the court currently, the case is expected to deal a blow to abortion rights.
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