A home test that checks whether a drug-induced abortion has worked is not only safe but reduces rates of unnecessary follow-up surgery, an Australian-first study has found.
People who attend clinics to access medication to terminate a pregnancy, known as a medical abortion, usually need to see a doctor 14 days later and may undergo a blood test to examine levels of a hormone known as hCG, along with an ultrasound to rule out complications.
Between March and July 2020, Marie Stopes International Australia (MSI), which provides abortion, contraception and vasectomy services nationally, trialled a urine test that is also accurate for detecting if a termination is successful, and combined this with a Telehealth appointment for all patients undergoing a medical abortion at their clinics.
The trial, which followed 2,223 patients across 14 MSI clinics, coincided with national Covid-19 restrictions being introduced, hindering travel and face-to-face appointments. The medical regulator, the Therapeutic Goods Administration (TGA), approved the urine test in November 2019, though it has been widely available in the UK for several years.
The results from the trial, published in the August edition of the Australian and New Zealand Journal of Obstetrics and Gynaecology, found the home care model was safe and effective.
The lead author of the study and deputy medical director of MSI, Dr Catriona Melville, said those who took part did not have to take time off work, travel to clinics or pay for associated expenses such as childcare to attend a follow-up appointment.
The study found no increase in rates of pregnancies continuing among those receiving follow-up care from home.
“That’s probably the most concerning thing for clients and the clinicians, we don’t want to miss a continuing pregnancy because there’s a very small complete failure rate with medical termination,” Melville said.
She said while patients often have a small amount of pregnancy tissue in the uterus after a medical abortion, routine ultrasounds often led to over-diagnosis of continued pregnancy and unnecessary surgeries. Those participating in her study had a lower rate of surgical intervention.
The study authors wrote that the trial offered “particular benefit to patients from regional, rural, and remote geographical areas as it reduces the burden of travel to clinics for appointments and can be used in the telehealth setting”.
Anna Noonan, a PhD candidate at the University of Sydney whose research is in rural access to abortion, sexual and reproductive health, said any changes which reduced the financial and logistical burdens of accessing abortion care were welcomed.
“We know that that’s where we start to see a departure between the experiences of people living in urban centres and the people living in non-urban centres,” Noonan said.
People in far-western New South Wales, which is the focus of Noonan’s research, have to travel anywhere between six and 11 hours to access an abortion clinic, with only one facility west of the Blue Mountains.
“When you’re having to travel to a bricks and mortar place that’s often far from home [it] is often what becomes the difficult … and sometimes inhibiting part of abortion experience for rural people. Not necessarily the procedure itself.”
A spokesperson for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists said the study addressed a topic that needed greater attention.
“Cost and accessibility of reproductive healthcare, including pregnancy care and termination services across Australia, particularly in regional and remote areas, needs to be addressed, and studies like this, which look at opportunities to reduce inequities and improve access to this essential component of reproductive healthcare, should be discussed.”