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"It was close enough, but it wasn't close enough": A qualitative exploration of the impact of direct-to-patient telemedicine abortion on access to abortion care.
Kerestes, Courtney; Delafield, Rebecca; Elia, Jennifer; Chong, Erica; Kaneshiro, Bliss; Soon, Reni.
  • Kerestes C; Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, United States. Electronic address: courtney.kerestes@gmail.com.
  • Delafield R; Department of Native Hawaiian Health, University of Hawai'i at Manoa, Honolulu, HI, United States.
  • Elia J; Early Childhood Action Strategy, Honolulu, HI, United States.
  • Chong E; Gynuity Health Projects, New York, NY, United States.
  • Kaneshiro B; Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, United States.
  • Soon R; Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, United States.
Contraception ; 104(1): 67-72, 2021 07.
Article in English | MEDLINE | ID: covidwho-1209438
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Postal Service / Abortifacient Agents / Attitude to Health / Abortion, Induced / Telemedicine / Health Services Accessibility Type of study: Experimental Studies / Prognostic study / Qualitative research / Randomized controlled trials Limits: Adolescent / Adult / Female / Humans / Middle aged / Pregnancy / Young adult Country/Region as subject: North America Language: English Journal: Contraception Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Postal Service / Abortifacient Agents / Attitude to Health / Abortion, Induced / Telemedicine / Health Services Accessibility Type of study: Experimental Studies / Prognostic study / Qualitative research / Randomized controlled trials Limits: Adolescent / Adult / Female / Humans / Middle aged / Pregnancy / Young adult Country/Region as subject: North America Language: English Journal: Contraception Year: 2021 Document Type: Article