Factors Associated With Use of an Online Telemedicine Service to Access Self-managed Medical Abortion in the US.
JAMA Netw Open
; 4(5): e2111852, 2021 05 03.
Article
in English
| MEDLINE | ID: covidwho-1245328
ABSTRACT
Importance People in the US have been seeking self-managed abortions outside the formal health care system using medications obtained through online telemedicine. However, little is known about this practice, including potential motivating factors. Objective:
To examine individual reasons for accessing medication abortion through an online telemedicine service as well as associations between state- and county-level factors and the rate of requests. Design, Setting, andParticipants:
This population-based cross-sectional study examined all requests for self-managed medication abortion through an online consultation form available from Aid Access, a telemedicine service in the US, between March 20, 2018, and March 20, 2020. Main Outcomes andMeasures:
Individual-level reasons for accessing the telemedicine service were examined as well as the rate of requests per 100â¯000 women of reproductive age by state. Zip code data provided by individuals making requests were used to examine county-level factors hypothesized to be associated with increased demand for self-managed abortion distance to a clinic (calculated using location data for US abortion clinics) and the population proportion identifying as a member of a racial/ethnic minority group, living below the federal poverty level, and having broadband internet access (calculated using census data).Results:
During the 2-year study period, 57â¯506 individuals in 2458 counties in 50 states requested self-managed medication abortion; 52.1% were aged 20 to 29 years (mean [SD] age, 25.9 [6.7] years), 50.0% had children, and 99.9% were 10 weeks' pregnant or less. The most common reasons cited by individuals making requests were the inability to afford in-clinic care (73.5%), privacy (49.3%), and clinic distance (40.4%). States with the highest rate of requests were Louisiana (202.7 per 100â¯000 women) and Mississippi (199.9 per 100â¯000 women). At the county level, an increase of 1 SD (47 miles) in distance to the nearest clinic was significantly associated with a 41% increase in requests (incidence rate ratio, 1.41; 95% CI, 1.31-1.51; P < .001), and a 10% increase in the population living below the federal poverty level was significantly associated with a 20% increase in requests (incidence rate ratio, 1.20; 95% CI, 1.13-1.28; P < .001). Conclusions and Relevance In this cross-sectional study, clinic access barriers were the most commonly cited reason for requesting self-managed medication abortion using an online telemedicine service. At the county level, distance to an abortion clinic and living below the federal poverty level were associated with a higher rate of requests. State and federal legislation could address these access barriers.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Abortifacient Agents, Nonsteroidal
/
Abortifacient Agents, Steroidal
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Mifepristone
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Misoprostol
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Abortion, Induced
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Telemedicine
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Self-Management
Type of study:
Observational study
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Prognostic study
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Randomized controlled trials
Limits:
Adolescent
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Adult
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Female
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Humans
/
Middle aged
/
Pregnancy
/
Young adult
Language:
English
Journal:
JAMA Netw Open
Year:
2021
Document Type:
Article
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