Advancing New Standards in Reproductive Health (ANSIRH) is based at the University of California San Francisco, USA, is a leading research programme that informs the most pressing debates on reproductive health, rights, and access. They are currently celebrating their 20th anniversary.
In December 2021 they published an editorial in BMJ Sexual & Reproductive Health, and on their website in March 2022, a report of research of their own – both on topics that go several big steps further in making abortion pills as accessible as possible and abortions as early as possible.
Their December report outlines a potential approach to an advance provision model, with clinicians screening patients for some contra-indications to medical abortion prior to pregnancy in addition to providing any necessary education. The research team sees advance provision as a “complete care model,” which would also include access to necessary follow-up care in case of complications, ongoing pregnancy, or incomplete abortion. At the same time, the researchers acknowledge possible challenges with the model, including self-administration at inappropriate times and medication diversion. Still, studies on its safety and how patients can use the medications with limited clinician oversight could provide contributory evidence toward an eventual move toward over-the-counter availability of mifepristone and misoprostol for medical abortion.
“While a future landscape of medication abortion may include telemedicine and mail-order pharmacy dispensing, advance provision may be a preferable option for those who would continue to face barriers to care, including those travelling to areas with limited options for safe abortion.”
Second, they have reported their research on whether abortions with pills are safe and effective without ultrasound. And indeed, they found they were, as the infographic above makes clear. They state that:
“Using this new model can expand the number of providers who can provide medication abortion to include primary care providers and others who may not have access to ultrasound technology. The high safety and effectiveness rates show that mandatory ultrasound laws are not rooted in scientific evidence and are medically unnecessary when it comes to medication abortion.”
Third, they published a new study that asked people seeking abortion a series of questions about how far along they thought they were in pregnancy. Researchers then compared their responses to the gestational duration on ultrasound. They found that broadening the screening questions beyond just the date of the last menstrual period resulted in improved accuracy of self-assessment of pregnancy duration. The key findings were:
17% of those in the study were not sure of the date of their last menstrual period (LMP). But fewer (3%) were not sure how many weeks pregnant they were, or whether they had missed more than two periods (6%). Using multiple pregnancy dating questions worked better at correctly identifying those who were >70 days (i.e. 10 weeks) pregnant. With these three questions – date of LMP, date they think they got pregnant, and their estimated number of weeks pregnant – only 2.7% incorrectly thought they were ≤70 days when they were actually >70 days.
Using three different questions instead, that did not rely on date of LMP – are you more than 10 weeks pregnant, or are you more than two months pregnant, or have you missed more than two periods – found that only 2.3% believed they were ≤70 days when they were actually >70 days.
Women on Web are already offering advance provision of abortion pills online
Women on Web (WOW), a major online abortion pill provider, now offer advance provision of abortion pills. Their reasoning: Providing access to abortion pills before they are needed overcomes restrictions to abortion care and enables women to access abortions earlier in their pregnancy.
On their website, you can choose either: 1) I need an abortion, or 2) Advance provision of abortion pills. With advance provision, there two steps:
– You can request abortion pills in advance and wait to use them until you discover you are pregnant.
– When you are ready to use them, you should contact WOW immediately so that they can guide you through the process.