Abstract
Objective
To understand how obtaining a medication abortion by mail with telemedicine counseling
versus traditional in-clinic care impacted participants’ access to care.
Study design
We conducted a qualitative study with semi-structured telephone interviews with individuals
who completed a medication abortion by mail through the TelAbortion study. We asked
participants how they learned about telemedicine abortion, reasons for choosing it,
what their alternative would have been, and about their experience. We transcribed,
coded, and performed qualitative content analysis of the interviews and are presenting
a subset of themes related to access to care when the restrictions on clinic dispensing
of mifepristone are removed.
Results
We interviewed 45 people from January to July 2020. Direct-to-patient telemedicine
abortion was more convenient and accessible than in-clinic abortion care when considering
the burdens of travel, clinic availability, logistics, and cost that were associated
with in-clinic abortion. Stigma led to a prioritization of privacy, and by going to
a clinic, participants feared a loss of privacy whereas obtaining a medication abortion
by mail made it easier to maintain confidentiality. Faced with these barriers, 13%
of participants stated they would have continued their pregnancy if TelAbortion had
not been an option. Participants found direct-to-patient telemedicine abortion to
be acceptable and recommended it to others. Benefits of telemedicine were amplified
during the COVID-19 pandemic due to concerns around infection exposure with in-clinic
care.
Conclusion
Going to a clinic was a burden for participants, to the point where some would not have otherwise been able to get an abortion. Medication
abortion by mail with telemedicine counseling was a highly acceptable alternative.
Implications
Medication abortion by mail can increase access to abortion with the added benefits
of increased perceived privacy and decreased logistical burdens. Removing the in-person
dispensing requirement for mifepristone would allow direct-to-patient telemedicine
abortion to be implemented outside of a research setting without compromising the
patient experience.
Keywords
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References
- First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review.Contraception. 2013; 87: 26-37
- Safety of medical abortion provided through telemedicine compared with in person.Obstet Gynecol. 2017; 130: 778-782
- A direct-to-patient telemedicine abortion service in Australia: retrospective analysis of the first 18 months.Aust N Z J Obstet Gynaecol. 2018; 58: 335-340
- Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland.BMJ. 2017; 357: j2011
- Telemedicine for medical abortion: a systematic review.BJOG. 2019; 126: 1094-1102
- Experiences of women in Ireland who accessed abortion by travelling abroad or by using abortion medication at home: a qualitative study.BMJ Sex Reprod Health. 2018; 44: 181-186
- Safety and acceptability of medical abortion through telemedicine after 9 weeks of gestation: a population-based cohort study.BJOG. 2019; 126: 609-618
- Effectiveness and acceptability of medical abortion provided through telemedicine.Obstet Gynecol. 2011; 118: 296-303
- Women's and providers' experiences with medical abortion provided through telemedicine: a qualitative study.Womens Health Issues. 2013; 23: e117-e122
- Women's experiences using telemedicine to attend abortion information visits in Utah: a qualitative study.Womens Health Issues. 2019; 29: 407-413
Mifepristone. Approved Risk Evaluation and Mitigation Strategies (REMS) 2019. https://www.accessdata.fda.gov/scripts/cder/rems/index.cfm?event=RemsDetails.page&REMS=390.
- Sixteen years of overregulation: time to unburden Mifeprex.N Engl J Med. 2017; 376: 790-794
- Disparities and change over time in distance women would need to travel to have an abortion in the USA: a spatial analysis.Lancet Public Health. 2017; 2: e493-e500
- Perceived access to abortion among women in the United States in 2018: variation by state abortion policy context.Am J Public Health. 2020; 110: 1039-1045
Investigational New Drug (IND) Application. U.S. Food and Drug Administration; 2021. https://www.fda.gov/drugs/types-applications/investigational-new-drug-ind-application
- TelAbortion: evaluation of a direct to patient telemedicine abortion service in the United States.Contraception. 2019; 100: 173-177
- Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic.Contraception. 2021; (In press)https://doi.org/10.1016/j.contraception.2021.03.019
- Qualitative content analysis.(editor.)in: Flick U The SAGE handbook of qualitative data analysis. SAGE Publications, London, United Kingdom2013
- Theme development in qualitative content analysis and thematic analysis.J Nurs Educ. 2016; 6: 100-110
- Patient-centred access to health care: conceptualising access at the interface of health systems and populations.Int J Equity Health. 2013; 12: 18
- Barriers to abortion care and their consequences for patients traveling for services: qualitative findings from two states.Perspect Sex Reprod Health. 2017; 49: 95-102
- Motivations and experiences of people seeking medication abortion online in the United States.Perspect Sex Reprod Health. 2018; 50: 157-163
Article info
Publication history
Published online: April 29, 2021
Accepted:
April 22,
2021
Received in revised form:
April 21,
2021
Received:
February 1,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
