To investigate the acceptability, feasibility, and effectiveness of dispensing medications
for abortion using a mail-order pharmacy following an in-person assessment.
We conducted a prospective cohort study of patients seeking medication abortion services
at 11 sites in seven states. Patients interested in and eligible for medication abortion
provided consent. Clinicians electronically sent prescribed mifepristone and misoprostol
to the mail-order pharmacy, which shipped these medications to participants’ preferred
addresses. Participants completed web-based surveys about their experience and outcomes
three days and 14 days post-enrollment and had routine clinical follow-up. Clinic
staff extracted clinical data from medical records. We performed descriptive analyses
to assess outcomes of interest.
Between January 2020 and April 2022, 408 participants enrolled, of which three enrolled
for two abortions (total sample: 411 pregnancies among 408 participants). Among the
94% (388/411) who took the medications and for whom clinical outcome data were obtained,
85% (329/388) received the medications within three days, 0.8% (3/388) took mifepristone
beyond 70 days’ gestation, and 1.6% (6/388) did not take misoprostol as indicated.
Complete medication abortion occurred in 380 cases (97.9%, CI, 96.0–99.1); among the
others, 1.8% (7/388) were treated with aspiration and one continued the pregnancy.
Almost all, 98% (380/388) and 94% (366/388) completed the day 3 and day 14 surveys,
respectively; and reported they were somewhat or very satisfied with mail-order dispensing
(96%, 365/380) and the medication abortion overall (92%, 338/366). No adverse events
related to mail-order dispensing occurred.
Mail-order pharmacy dispensing of mifepristone for medication abortion is safe, feasible,
acceptable, and effective for patients.