Efficacy of medical abortion through telemedicine versus standard provision – a randomised controlled non-inferiority trial

Unintended pregnancy remains a significant public health issue globally and in Sweden.

Approximately half of all pregnancies in Sweden are unintended, and the country has one of the highest abortion rates in Europe; the highest rates are among women 20 to 30-years of age. Medical abortion was first invented by our research group.

Globally the introduction of medical abortion has led to a reduction in unsafe abortions and subsequent reductions in maternal mortality and morbidity.

Systematic development of medical abortion has led to a simplified, de-medicalized treatment that can be task shifted from doctors to midwives.

We hypothesize that simplified, medical abortion can be further task shifted to women themselves through telemedicine provision of counselling and medical abortion procurement.

We have shown that abortion through telemedicine is safe, acceptable and with outcomes similar to standard in-clinic provision.

However, more information is needed from high income countries such as Sweden and from well-designed trials in order to develop evidence based clinical guidelines and recommendations.

We expect that the results of this large randomized trial on telemedicine provision of medical abortion versus in-clinic care will highlight the importance of an easily accessible safe and effective de-medicalized abortion provision and thus provide the evidence needed to task shift abortion care from clinicians to women themselves with subsequent earlier treatment, increased flexibility, reduced costs and increased autonomy for women.

Furthermore, the need for self-care and telemedicine has become evident during the current Corona pandemic. Thus, the project is of highest importance to ensure access to safe abortion care globally.