Telemedicine versus standard care for early medical abortion in South Africa: a randomized controlled non-inferiority trial

AimTo assess if abortion by telemedicine in a low-resource setting is equally feasible, effective, safe and acceptable to women as standard care.Organization/methodsThis study is a collaboration between the University of Cape Town and Karolinska Institutet.

In a randomized non-inferiority trial we will compare the feasibility, effectiveness, safety and acceptability of medical abortion through telemedicine compared to standard care among 1000 women requesting abortion at ≤9 gestational weeks at four community health centres (CHC) in Cape Town, between January 2021 and June 2022.

The telemedicine intervention will differ from standard care in four ways:Eligibility screening, abortion and contraceptive counseling will occur through an online abortion service (Women on Web)Instructions for the abortion will be sent to the woman´s Facebook messengerThe physical exam will not routinely include an ultrasoundBoth mifepristone and misoprostol will be taken at homeSignificance97% of unsafe abortions occur among poor and marginalized women who often have the least access to safe and non-stigmatizing services.

We hypothesize that women in these settings are able to safely and effectively perform a medical abortion through telemedicine if this service is adapted to their context and requirements.

Investigating abortion care models that circumvent barriers to access is essential in order to reduce abortion–related deaths.