Demand for Self-Managed Online Telemedicine Abortion in Eight European Countries During the COVID-19 Pandemic: A Regression Discontinuity Analysis (preprint)

ABSTRACT

ObjectivesIn most European countries, patients seeking medication abortion during the COVID-19 pandemic are still expected to attend healthcare settings in person despite lockdown measures and infection risk. We assessed whether demand for self-managed medication abortion provided by a fully remote online telemedicine service increased following the emergence of COVID-19. DesignWe used regression discontinuity to compare the number of requests to online telemedicine service Women on Web in eight European countries before and after they implemented lockdown measures to slow COVID-19 transmission. We examined the number deaths due to COVID-19, the degree of government-provided economic support, the severity of lockdown travel restrictions, and the medication abortion service provision model in countries with and without significant changes in requests. SettingEight European countries served by Women on Web. Participants3,915 people who made requests for self-managed abortion to Women on Web between January 1st, 2019 and June 1st, 2020. Main Outcome MeasuresPercent change in requests to Women on Web before and after the emergence of COVID-19 and associated lockdown measures. ResultsFive countries showed significant increases in requests, ranging from 28% in Northern Ireland (p=0.001) to 139% in Portugal (p<0.001). Two countries showed no significant change in requests, and one country, Great Britain, showed an 88% decrease in requests (p<0.001). Countries with significant increases in requests were either countries where abortion services are mainly provided in hospitals or where no abortion services are available and international travel was prohibited during lockdown. By contrast, Great Britain authorized teleconsultation for medication abortion and provision of medications by mail during the pandemic. ConclusionThese marked changes in requests for self-managed medication abortion during COVID-19 demonstrate demand for fully remote models of abortion care and an urgent need for policymakers to expand access to medication abortion by telemedicine. O_TEXTBOXO_TEXTBOXNOWhat this paper addsC_TEXTBOXNO What is already know on this subjectO_LIThe COVID-19 pandemic has presented challenges to patients seeking medication abortion, including lockdown travel restrictions and infection risk during in-person clinic visits. C_LIO_LIYet in most European countries, medication abortion must still be provided through in-person models of care. The sole exception is Great Britain, where a fully remote medication abortion service was introduced in response to the pandemic. C_LIO_LIAnecdotal reports suggest that patients are struggling to access in-person abortion services and may turn to self-managed abortion as a result. However, to date there has been no systematic assessment of this possibility. C_LI What this study addsO_LIOur study provides the best evidence to date that demand for self-managed medication abortion provided using online telemedicine increased following the emergence of the COVID-19 pandemic. C_LIO_LIThe largest increases were observed in countries where medication abortion is provided mainly in hospitals and where travel restrictions were most stringent. By contrast, in the one country that implemented fully remote services, demand for self-managed abortion declined almost to zero. C_LIO_LIOur findings demonstrate the urgent need for policymakers to expand access to telemedicine models of medication abortion within the formal healthcare setting. C_LI C_TEXTBOX