1
|
Luchetti G, Albardonedo V, Alfonso MV. [Women's rescuers network: Community support for self-managed abortion in Argentina]. Salud Colect 2024; 20:e4810. [PMID: 38992339 DOI: 10.18294/sc.2024.4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/30/2024] [Indexed: 07/13/2024] Open
Abstract
The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.
Collapse
Affiliation(s)
- Gabriela Luchetti
- Médica, ginecóloga-obstetra. Magíster en Genero Sociedad y Políticas. Profesora adjunta, Facultad de Medicina, Universidad Nacional del Comahue, Neuquén, Argentina
| | - Valeria Albardonedo
- Licenciada en Comunicación Social. Magíster en Ciencias Sociales. Asistente Docencia, Facultad de Medicina, Universidad Nacional del Comahue, Neuquén, Argentina
| | - María Victoria Alfonso
- Licenciada en Comunicación Social. Magíster en Política y Gestión de la Ciencia y la Tecnología. Secretaria, Consejo Superior, Universidad Nacional del Comahue, Neuquén, Argentina
| |
Collapse
|
2
|
Seymour JW, Melville C, Grossman D, Thompson TA. Examining service delivery patterns before and after implementation of a direct-to-patient telehealth service providing medication abortion in Australia. Aust N Z J Obstet Gynaecol 2024. [PMID: 38874224 DOI: 10.1111/ajo.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/19/2024] [Indexed: 06/15/2024]
Abstract
In August 2016, MSI Australia (MSIA) brought to scale a direct-to-patient telehealth medication abortion service. We used MSIA's patient management systems from January 2015 to December 2018 to assess changes in the proportion of abortion patients obtaining care after 13 weeks' gestation, proportion of abortion patients obtaining medication abortion versus procedural abortion and proportion of abortion patients from regional and remote versus metropolitan areas. The proportions of abortion patients obtaining care before 13 weeks' gestational duration and those from regional and remote residents did not change between the pre- and post-periods. We observed an increase in medication abortion use that was greater among those in regional and remote areas than those in metropolitan areas.
Collapse
Affiliation(s)
- Jane W Seymour
- Collaborative for Reproductive Equity, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | | | - Daniel Grossman
- Advancing New Standards in Reproductive Health, University of California San Francisco, Oakland, California, USA
| | | |
Collapse
|
3
|
Tsereteli T, Platais I, Maru M, Maystruk G, Kurbanbekova D, Rzayeva G, Winikoff B. Evaluation of telemedicine medical abortion using a no-test protocol in the Eastern Europe and Central Asian region: Evidence from Ukraine, Uzbekistan, and Azerbaijan. Int J Gynaecol Obstet 2024. [PMID: 38803127 DOI: 10.1002/ijgo.15708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/10/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To evaluate safety, feasibility, and acceptability of a telemedicine medical abortion service without pre-treatment in-person tests in Ukraine, Uzbekistan, and Azerbaijan. METHODS We conducted an open-label, prospective, observational clinical study at five clinics in the three countries. Interested and eligible participants scheduled a telemedicine consultation with a study provider by phone or video. Medical abortion pills could be obtained by mail or courier or picked up at the study clinic or a pharmacy. Study providers contacted participants 1 week after mifepristone ingestion to assess abortion outcomes based on symptoms, and 3 weeks later to review the result of an at-home, high-sensitivity, urine pregnancy test. Participants were referred to in-person visit based on symptoms, urine pregnancy test results, or initiative by the participant. RESULTS In all, 300 women participated in the study. Almost all participants received medical abortion medications the same day as their first contact with the study clinic, and the majority (n = 297, 99.0%) did not experience any problems receiving them. All except two women (0.67%) followed provider instructions on administration of medications. The majority of participants had a complete abortion without a procedure (Ukraine: n = 115, 95.8%; Uzbekistan: n = 127, 97.7%; Azerbaijan: n = 49, 98.0%), few had in-person visits (Ukraine: n = 30, 25.0%; Uzbekistan: n = 3, 2.3%; Azerbaijan: n = 4, 8.0%), and most were very satisfied or satisfied with the service (Ukraine: n = 116, 96%; Uzbekistan: n = 128, 98%; Azerbaijan: n = 45, 90%). No serious adverse events occurred. CONCLUSION Telemedicine medical abortion using the no-test protocol is safe, feasible and acceptable for women in Ukraine, Uzbekistan, and Azerbaijan.
Collapse
Affiliation(s)
| | - Ingrida Platais
- Gynuity Health Projects, New York, New York, USA
- New York University Grossman School of Medicine, New York, New York, USA
| | - Mahlet Maru
- Gynuity Health Projects, New York, New York, USA
| | - Galyna Maystruk
- Charitable Foundation Women Health and Family Planning, Kyiv, Ukraine
| | | | - Gulnara Rzayeva
- Scientific-Research Institute of Obstetrics and Gynecology, Baku, Azerbaijan
| | | |
Collapse
|
4
|
Dunlop H, Sinay AM, Kerestes C. Telemedicine Abortion. Clin Obstet Gynecol 2023; 66:725-738. [PMID: 37910115 DOI: 10.1097/grf.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Telemedicine has become a substantial part of abortion care in recent years. In this review, we discuss the history and regulatory landscape of telemedicine for medication abortion in the United States, different models of care for telemedicine, and the safety and effectiveness of medication abortion via telemedicine, including using history-based screening protocols for medication abortion without ultrasound. We also explore the acceptability of telemedicine for patients and their perspectives on its benefits, as well as the use of telemedicine for other parts of abortion care. Telemedicine has expanded access to abortion for many, although there remain limitations to its implementation.
Collapse
Affiliation(s)
| | - Anne-Marie Sinay
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Courtney Kerestes
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| |
Collapse
|
5
|
Adu J, Roemer M, Page G, Dekonor E, Akanlu G, Fofie C, Teye MD, Afriyie PO, Affram AA, Ohemeng F, Tabong PTN, Dwomoh D. Expanding access to early medical abortion services in Ghana with telemedicine: findings from a pilot evaluation. Sex Reprod Health Matters 2023; 31:2250621. [PMID: 37728548 PMCID: PMC10512762 DOI: 10.1080/26410397.2023.2250621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Abortion in Ghana is legally permissible under certain conditions. Updated in June 2021, the National Comprehensive Abortion Care Services Standards and Protocols included telemedicine as a recognised option for early medical abortion (EMA). Subsequently, Marie Stopes Ghana launched this pilot project to understand the feasibility and acceptability of providing EMA services through telemedicine. The pilot evaluation drew on two research protocols - a process evaluation and a qualitative study. The process evaluation focused on existing routine data sources and additional pilot-specific monitoring, while the qualitative protocol included in-depth interviews with a range of key stakeholders, including telemedicine and in-person patients, healthcare managers, and service providers. Telemedicine for EMA is feasible, acceptable, and has likely expanded access to safe abortion in Ghana. The MSIG telemedicine service package enabled 97% of patients to have a successful EMA at home. Thirty-six per cent of the total 878 patients during the pilot reported that they had no other option for accessing an abortion. Patients described telemedicine EMA services as a highly acceptable and appealing service option. Eighty-four per cent reported they would opt for the telemedicine service again and 83% reported they were very likely to recommend the service. There is potential for telemedicine to expand and improve access to critical SRH services. EMA via telemedicine can be delivered effectively in a low-resource setting. This pilot also showed how telemedicine provides access to patients who feel they do not have other safe service options, meeting specific patient needs in terms of discretion, convenience, and timing.
Collapse
Affiliation(s)
- Joseph Adu
- Director of Medical Services, MSI Reproductive Choices, Ghana
| | - Matthea Roemer
- Innovation, Evidence and Research Manager, MSI Reproductive Choices, Accra, Ghana
| | - Georgina Page
- Head of SBC and Inclusion, MSI Reproductive Choices, Accra, Ghana
| | - Elymas Dekonor
- Head of Marketing, MSI Reproductive Choices, Accra, Ghana
| | - George Akanlu
- Country Director, MSI Reproductive Choices, Accra, Ghana
| | - Chris Fofie
- Deputy Director, Reproductive and Child Health, Ghana Health Services, Accra, Ghana
| | | | - Patricia Opoku Afriyie
- Monitoring, Evaluation, Research and Learning (MERL) Manager, MSI Reproductive Choices, Ghana
| | - Adjeiwa Akosua Affram
- PhD Candidate, Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Fidelia Ohemeng
- Senior Lecturer, Department of Sociology, University of Ghana, Accra, Ghana
| | - Philip Teg-Nefaah Tabong
- Lecturer, Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Duah Dwomoh
- Director, D&D Statistical Consulting Services Limited, Accra, Ghana
| |
Collapse
|
6
|
Reynolds-Wright JJ, Norrie J, Cameron ST. Using telemedicine to improve early medical abortion at home (UTAH): a randomised controlled trial to compare telemedicine with in-person consultation for early medical abortion. BMJ Open 2023; 13:e073630. [PMID: 37709327 PMCID: PMC10870195 DOI: 10.1136/bmjopen-2023-073630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES To compare telephone consultations with in-person consultations for the provision of medical abortion (using mifepristone 200 mg and misoprostol 800 µg). We hypothesised that telemedicine consultations would be non-inferior to in-person consultations with a non-inferiority limit of 3%. DESIGN Randomised controlled trial with 1:1 allocation. SETTING Community abortion service housed within an integrated sexual and reproductive health service in Edinburgh, UK. PARTICIPANTS The trial began on 13 January 2020, but was stopped early due to COVID-19; recruitment was suspended on 31 March 2020, and was formally closed on 31 August 2021. A total of 125 participants were randomised, approximately 10% of the total planned, with 63 assigned to telemedicine and 62 to in-person consultation. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: efficacy of medical abortion, defined as complete abortion without surgical intervention. SECONDARY OUTCOMES satisfaction with consultation type, preparedness, unscheduled contact with care, complication rate, time spent in clinical contact and uptake of long-acting contraception. RESULTS Primary outcome was available for 115 participants (lost-to-follow-up telemedicine=2, in-person=8), secondary outcomes were available for 110 participants (n=5 and n=10 in telemedicine and in-person groups did not complete questionnaires). There were no significant differences between groups in treatment efficacy (telemedicine 57/63 (90.5%), in-person 48/62 (77.4%)). However, non-inferiority was not demonstrated (+3.3% in favour of telemedicine, CI -6.6% to +13.3%, lower than non-inferiority margin). There were no significant differences in most secondary outcomes, however, there was more unscheduled contact with care in the telemedicine group (12 (19%) vs 3 (5%), p=0.01). The overall time spent in clinical contact was statistically significantly lower in the telemedicine group (mean 94 (SD 24) vs 111 (24) min, p=0.0005). CONCLUSIONS Telemedicine for medical abortion appeared to be effective, safe and acceptable to women, with less time spent in the clinic. However, due to the small sample size resulting from early cessation, the study was underpowered to confirm this conclusion. These findings warrant further investigation in larger scale studies. TRIAL REGISTRATION NUMBER NCT04139382.
Collapse
Affiliation(s)
- John Joseph Reynolds-Wright
- MRC Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
- Chalmers Centre for Sexual Health, NHS Lothian, Edinburgh, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Bioquarter, Edinburgh, UK
| | - Sharon Tracey Cameron
- MRC Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
- Chalmers Centre for Sexual Health, NHS Lothian, Edinburgh, UK
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
7
|
Pearlman Shapiro M, Myo M, Chen T, Nathan A, Raidoo S. Remote Provision of Medication Abortion and Contraception Through Telemedicine. Obstet Gynecol 2023:00006250-990000000-00746. [PMID: 37054393 DOI: 10.1097/aog.0000000000005205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/23/2023] [Indexed: 04/15/2023]
Abstract
This Narrative Review describes the remote provision of family planning services, including medication abortion and contraception, through telemedicine. The coronavirus disease 2019 (COVID-19) pandemic was a catalyst to shift toward telemedicine to maintain and expand access to crucial reproductive health services when public health measures necessitated social distancing. There are legal and political considerations when providing medication abortion through telemedicine, along with unique challenges, even more so after the Dobbs decision starkly limited options for much of the country. This review includes the literature describing the logistics of telemedicine and modes of delivery for medication abortion and details special considerations for contraceptive counseling. Health care professionals should feel empowered to adopt telemedicine practices to provide family planning services to their patients.
Collapse
Affiliation(s)
- Marit Pearlman Shapiro
- University of Southern California, Los Angeles, and the University of California, San Diego, La Jolla, California; and the University of Hawaii, Honolulu, Hawaii
| | | | | | | | | |
Collapse
|
8
|
Mazza D, Shankar M, Botfield JR, Moulton JE, Chakraborty SP, Black K, Tomnay J, Bateson D, Church J, Laba TL, Kasza J, Norman WV. Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice. BMJ Open 2023; 13:e065137. [PMID: 36948556 PMCID: PMC10040016 DOI: 10.1136/bmjopen-2022-065137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Women living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas. METHODS AND ANALYSIS ORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women's health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases; secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has the potential to increase LARC and medical abortion access in rural and regional Australia. ETHICS AND DISSEMINATION Ethics approval was obtained from the Monash University Human Research Ethics Committee (Project ID: 29476). Findings will be disseminated via multiple avenues including a knowledge exchange workshop, policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763).
Collapse
Affiliation(s)
- Danielle Mazza
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Mridula Shankar
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Jessica R Botfield
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Jessica E Moulton
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Samantha Paubrey Chakraborty
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Kirsten Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Tomnay
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Jody Church
- Centre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health and Policy, Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
9
|
Rosenberg JD, Raymond E, Shochet T. An examination of loss to follow-up and potential bias in outcome ascertainment in a study of direct-to-patient telemedicine abortion in the United States. Contraception 2023; 122:109996. [PMID: 36841460 DOI: 10.1016/j.contraception.2023.109996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES To examine associations between factors associated with loss to follow-up and effectiveness in the TelAbortion project, which provided medication abortion by direct-to-patient telemedicine and mail in the United States. STUDY DESIGN The study population for this descriptive analysis included abortions among participants enrolled in the TelAbortion study with data present in a web-based database tool from November 2018 to September 2021 who were mailed a medication package. The analysis included information on abortions across nine sites. In this analysis, we used generalized estimating equations to examine factors associated with loss to follow-up and effectiveness. RESULTS Of the 1831 abortions included in this analysis, 1553 (84.8%) were classified as having complete follow-up and 278 (15.2%) were classified as lost to follow-up. In a multivariable analysis, factors significantly associated with loss to follow-up included history of medical abortion, education, gestational age, study site, and whether the TelAbortion was performed pre- or post-COVID-19 onset (p < 0.05). The rate of treatment failure (i.e., abortions resulting in continuing pregnancy or uterine evacuation) reported in this study was 5.1%. The only covariate associated with both loss to follow-up and treatment failure was higher gestational age. However, using gestational age to impute missing abortion outcomes did not substantially change the estimated failure rate. CONCLUSIONS Abortions that were lost to follow-up differed substantially from those with complete follow-up, which could bias the effectiveness estimate. However, imputing outcomes based on available and appropriate pretreatment data did not substantially affect the estimate. This finding is encouraging, although it does not exclude the possibility of bias due to unmeasured factors. IMPLICATIONS Significant differences between abortion cases with complete follow-up and those lost to follow-up provide insights into abortion cases that may be at a higher risk for being lost. The low treatment failure rate indicates that the telemedicine provision of medication abortion is effective.
Collapse
Affiliation(s)
- Jessica D Rosenberg
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; Guttmacher Institute, New York, NY, USA.
| | | | | |
Collapse
|
10
|
Wollum A, Zuniga C, Grindlay K, Grossman D. Who Accesses Birth Control Online? An Analysis of Requests for Contraception Submitted to an Online Prescribing Platform in the United States. Womens Health Issues 2023; 33:25-35. [PMID: 36182640 DOI: 10.1016/j.whi.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Telehealth has the potential to increase contraceptive access. Little is known about the characteristics of people using online prescribing platforms or whether these services help fill access gaps. METHODS We analyzed requests for contraception submitted between July 2015 and September 2017 to an online prescribing platform that offers sexual and reproductive care in the United States. We analyzed the characteristics of people seeking contraceptives, prevalence of contraindications to hormonal contraception among contraceptive seekers, and extent to which online prescribing may close contraceptive access gaps. RESULTS A total of 38,439 requests for prescription hormonal birth control were received during the study period, with requests increasing dramatically over this timeframe as the platform expanded operations to an increasing number of states. Methods were dispensed in response to 63% of requests. In this population seeking contraception, an estimated 1.2% had a contraindication to progestin-only pills, and an estimated 12.0% of patients who reported their blood pressure had a contraindication to combined hormonal methods. Few requests came from patients younger than 18 (1.2%). In multivariable negative binomial models, urban counties had a larger concentration of requests, whereas counties with higher rates of uninsurance and poverty had lower rates of requests. CONCLUSIONS Results suggest that the population seeking contraception from one online prescribing platform has similar levels of contraindications to hormonal contraceptives as found in prior research. Future research should seek to understand why utilization of this online prescribing platform was lower among young people, how to expand outreach to rural populations, and what underlies individuals' decisions about using these services.
Collapse
Affiliation(s)
| | | | | | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| |
Collapse
|
11
|
Mazza D, Botfield JR. Opportunities for Increasing Access to Effective Contraception in Australia. Semin Reprod Med 2022; 40:240-245. [PMID: 36478566 DOI: 10.1055/s-0042-1759554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling.
Collapse
Affiliation(s)
- Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Ehrenreich K, Biggs MA, Grossman D. Making the case for advance provision of mifepristone and misoprostol for abortion in the United States. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:238-242. [PMID: 34862207 DOI: 10.1136/bmjsrh-2021-201321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Katherine Ehrenreich
- Advancing New Standards In Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| | - M Antonia Biggs
- Advancing New Standards In Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| | - Daniel Grossman
- Advancing New Standards In Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| |
Collapse
|
13
|
Fiastro AE, Sanan S, Jacob-Files E, Wells E, Coeytaux F, Ruben MR, Bennett IM, Godfrey EM. Remote Delivery in Reproductive Health Care: Operation of Direct-to-Patient Telehealth Medication Abortion Services in Diverse Settings. Ann Fam Med 2022; 20:336-342. [PMID: 35831175 PMCID: PMC9328706 DOI: 10.1370/afm.2821] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Established models of reproductive health service delivery were disrupted by the coronavirus disease 2019 (COVID-19) pandemic. This study examines rapid innovation of remote abortion service operations across health care settings and describes the use of telehealth consultations with medications delivered directly to patients. METHODS We conducted semi-structured interviews with 21 clinical staff from 4 practice settings: family planning clinics, online medical services, and primary care practices-independent or within multispecialty health systems. Clinicians and administrators described their telehealth abortion services. Interviews were recorded, transcribed, and analyzed. Staff roles, policies, and procedures were compared across practice settings. RESULTS Across all practice settings, telehealth abortion services consisted of 5 operational steps: patient engagement, care consultations, payment, medication dispensing, and follow-up communication. Online services and independent primary care practices used asynchronous methods to determine eligibility and complete consultations, resulting in more efficient services (2-5 minutes), while family planning and health system clinics used synchronous video encounters requiring 10-30 minutes of clinician time. Family planning and health system primary care clinics mailed medications from clinic stock or internal pharmacies, while independent primary care practices and online services often used mail-order pharmacies. Online services offered patients asynchronous follow-up; other practice settings scheduled synchronous appointments. CONCLUSIONS Rapid innovations implemented in response to disrupted in-person reproductive health care included remote medication abortion services with telehealth assessment/follow-up and mailed medications. Though consistent operational steps were identified across health care settings, variation allowed for adaptation of services to individual sites. Understanding remote abortion service operations may facilitate dissemination of a range of patient-centered reproductive health services.Annals "Online First" article.
Collapse
Affiliation(s)
- Anna E Fiastro
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Sajal Sanan
- Department of Family Medicine, University of Washington, Seattle, Washington
| | | | | | | | - Molly R Ruben
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Ian M Bennett
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Emily M Godfrey
- Department of Family Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
14
|
Reynolds-Wright JJ, Boydell N, Cameron S, Harden J. A qualitative study of abortion care providers' perspectives on telemedicine medical abortion provision in the context of COVID-19. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:199-204. [PMID: 34848554 PMCID: PMC8635885 DOI: 10.1136/bmjsrh-2021-201309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Telemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective and highly acceptable to patients. Less is known about the perspectives of abortion care providers (ACPs). METHODS Qualitative research within the telemedicine abortion service in Lothian (Edinburgh and surrounding region), UK. We conducted qualitative in-depth interviews with ACPs between May and July 2020 (doctors, n=6; nurses, n=10) and analysed the data thematically. RESULTS We present three themes from our qualitative analysis: (1) Selective use of ultrasound - the move away from routine ultrasound for determination of gestational age was generally viewed positively. Initial anxiety about non-detection of ectopic pregnancy and later gestations was expressed by some ACPs, but concerns were addressed through clinical practice and support structures within the clinic. (2) Identifying safeguarding issues - in the absence of visual cues some ACPs reported concerns about their ability to identify safeguarding issues, specifically domestic violence. Conversely it was acknowledged that teleconsultations may improve detection of this in some situations. (3) Provision of information during the consultation - telephone consultations were considered more focused than in-person consultations and formed only part of the overall 'package' of information provided to patients, supplemented by online and written information. CONCLUSIONS ACPs providing telemedicine abortion care value this option for patients and believe it should remain beyond the COVID-19 pandemic. Safeguarding patients and the selective use of ultrasound can be initially challenging; however, with experience, staff confidence improves.
Collapse
Affiliation(s)
- John Joseph Reynolds-Wright
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Chalmers Centre, NHS Lothian, Edinburgh, UK
| | - Nicola Boydell
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Sharon Cameron
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Chalmers Centre, NHS Lothian, Edinburgh, UK
| | - Jeni Harden
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
15
|
Seymour JW, Melville C, Thompson TA, Grossman D. Effectiveness and safety of a direct-to-patient telehealth service providing medication abortion targeted at rural and remote populations: Cross-sectional findings from Marie Stopes Australia. Contraception 2022; 115:67-68. [PMID: 35753405 DOI: 10.1016/j.contraception.2022.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We assessed the safety and effectiveness of direct-to-patient telehealth provision of medication abortion in Australia. STUDY DESIGN We included all medication abortions (January 2017-December 2018) from Marie Stopes Australia's patient management and adverse event reporting systems. We defined effectiveness as whether the patient had a continuing pregnancy, incomplete abortion, and/or subsequent vacuum aspiration or procedural abortion and safety as whether the patient experienced any adverse event. RESULTS Direct-to-patient telehealth was more effective than in-clinic provision (97.2% versus 95.4%). The proportion of adverse events did not differ between groups. CONCLUSIONS This direct-to-patient telehealth service is safe and effective.
Collapse
Affiliation(s)
| | | | | | - Daniel Grossman
- Advancing New Standards in Reproductive Health, University of California San Francisco, Oakland, CA, United States
| |
Collapse
|
16
|
Melville C. Abortion care in Australasia: A matter of health, not politics or religion. Aust N Z J Obstet Gynaecol 2022; 62:187-189. [PMID: 35482706 DOI: 10.1111/ajo.13501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
|
17
|
Thompson TA, Seymour JW, Melville C, Khan Z, Mazza D, Grossman D. An observational study of patient experiences with a direct-to-patient telehealth abortion model in Australia. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:103-109. [PMID: 34531258 DOI: 10.1136/bmjsrh-2021-201259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND While abortion care is widely legal in Australia, access to care is often poor. Many Australians must travel long distances or interstate to access abortion care, while others face stigma when seeking care. Telehealth-at-home medical abortion is a potential solution to these challenges. In this study, we compared the experience of accessing an abortion via telehealth-at-home to accessing care in-clinic. METHODS Over a 20-month period, we surveyed patients who received medical abortion services at Marie Stopes Australia via the telehealth-at-home service or in-clinic. We conducted bivariate analyses to assess differences in reported acceptability and accessibility by delivery model. RESULTS In total, 389 patients were included in the study: 216 who received medical abortion services in-clinic and 173 through the telehealth-at-home service. Telehealth-at-home and in-clinic patients reported similarly high levels of acceptability: satisfaction with the service (82% vs 82%), provider interaction (93% vs 84%), and recommending the service to a friend (73% vs 72%). Only 1% of telehealth-at-home patients reported that they would have preferred to be in the same room as the provider. While median time between discovering the pregnancy to first contact with a clinic was similar between groups, median time from first contact to taking the first abortion medication was 7 days longer for telehealth-at-home patients versus in-clinic patients (14 days (IQR 9-21) vs 7 days (IQR 4-14); p<0.01). CONCLUSION The telehealth-at-home medical abortion service has the potential to address some of the challenges with provision of abortion care in Australia.
Collapse
Affiliation(s)
| | | | | | - Zara Khan
- The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| |
Collapse
|
18
|
Dragoman M, Fofie C, Bergen S, Chavkin W. Integrating self-managed medication abortion with medical care. Contraception 2021; 108:1-3. [PMID: 34971608 DOI: 10.1016/j.contraception.2021.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
In this commentary, we distill key messages from a new framework for self-managed medication abortion developed by Global Doctors for Choice. Since Global Doctors for Choice supports doctors working in different contexts around the world, the document also highlights clinical concerns and advocacy opportunities for clinicians in both low- and high-resource settings, and in places with varying legal and administrative restrictions on abortion.
Collapse
Affiliation(s)
| | - Chris Fofie
- Global Doctors for Choice Ghana, Accra, Ghana
| | - Sadie Bergen
- Columbia University Mailman School of Public Health, New York City, USA
| | | |
Collapse
|
19
|
Mazza D, Seymour JW, Sandhu MV, Melville C, O Rsquo Brien J, Thompson TA. General practitioner knowledge of and engagement with telehealth-at-home medical abortion provision. Aust J Prim Health 2021; 27:456-461. [PMID: 34782057 DOI: 10.1071/py20297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
In Australia, there are many barriers to abortion, particularly for women living in regional, rural and remote areas. Telehealth provision of medical abortion is safe, effective and acceptable to patients and providers. In 2015, Marie Stopes Australia (MSA) launched an at-home telehealth model for medical abortion to which GPs could refer. Between April and November of 2017, we interviewed 20 GPs who referred patients to MSA's telehealth-at-home abortion service to better understand their experiences and perspectives regarding telehealth-at-home abortion. We found that there was widespread support and recognition of the benefits of telehealth-at-home abortion in increasing access to abortion and reducing travel and costs. However, the GPs interviewed lacked knowledge and understanding of the processes involved in medical abortion, and many were unaware of the availability of telehealth as an option until a patient requested a referral. The GPs interviewed called for increased communication between telehealth-at-home abortion providers and GPs. Increasing GP familiarity with medical abortion and awareness of the availability of telehealth-at-home abortion may assist people in accessing safe, effective medical abortion.
Collapse
Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Vic. 3168, Australia
| | | | | | | | | | - Terri-Ann Thompson
- Ibis Reproductive Health, Cambridge, MA 02140, USA; and Corresponding author.
| |
Collapse
|
20
|
Parsons JA, Romanis EC. The Case for Telemedical Early Medical Abortion in England: Dispelling Adult Safeguarding Concerns. HEALTH CARE ANALYSIS 2021; 30:73-96. [PMID: 34687384 PMCID: PMC8540868 DOI: 10.1007/s10728-021-00439-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/04/2022]
Abstract
Access to abortion care has been hugely affected by the COVID-19 pandemic. This has prompted several governments to permit the use of telemedicine for fully remote care pathways, thereby ensuring pregnant people are still able to access services. One such government is that of England, where these new care pathways have been publicly scrutinised. Those opposed to telemedical early medical abortion care have raised myriad concerns, though they largely centre on matters of patient safeguarding. It is argued that healthcare professionals cannot adequately carry out their safeguarding duties if the patient is not in the room with them. These concerns lack empirical support. Emerging evidence suggests that safeguarding processes may, in fact, be more effective within telemedical abortion care pathways. In this article, we address two specific safeguarding concerns: (1) that a remote consultation prevents a healthcare professional from identifying instances of abuse, and (2) that healthcare professionals cannot reliably confirm the absence of coercion during a remote consultation. We demonstrate that such concerns are misplaced, and that safeguarding may actually be improved in telemedical care pathways as victims of abuse may find it easier to engage with services. It is inevitable that some individuals will fall through the net, but this is unavoidable even with in-person care and thus does not constitute a strong critique of the use of telemedicine in abortion care. These safeguarding concerns set aside, then, we argue that the current approval that enables telemedical early medical abortion should be afforded permanence.
Collapse
|
21
|
Reynolds-Wright JJ, Johnstone A, McCabe K, Evans E, Cameron S. Telemedicine medical abortion at home under 12 weeks' gestation: a prospective observational cohort study during the COVID-19 pandemic. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:246-251. [PMID: 33542062 PMCID: PMC7868129 DOI: 10.1136/bmjsrh-2020-200976] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND In response to the COVID-19 pandemic, legislation and guidance were introduced in Scotland permitting medical abortion at home by telemedicine for pregnancies at less than 12 weeks' gestation. Women had a telephone consultation with a clinician. Routine ultrasound was not performed. Medications and a low-sensitivity pregnancy test to confirm success of treatment were collected by or delivered to the woman, with telephone support provided as needed. METHODS A prospective cohort study of 663 women choosing medical abortion at home via the NHS Lothian telemedicine abortion service between 1 April and 9 July 2020. Interviewer-administered questionnaires were completed 4 and 14 days following treatment. Regional hospital databases were reviewed to verify abortion outcomes and complications within 6 weeks. Outcome measures included efficacy, complications and acceptability. RESULTS Almost all (642/663, 98.2%) the women were under 10 weeks' gestation. For 522/663 (78.7%) women, gestation was determined using last menstrual period alone. Some 650/663 (98%) women had a complete abortion, 5 (0.8%) an ongoing pregnancy and 4 (0.6%) an incomplete abortion. No one was treated inadvertently beyond 12 weeks' gestation, but one woman was never pregnant. One woman who had a pre-abortion ultrasound was later managed as a caesarean scar ectopic. There were two cases of haemorrhage and no severe infections. Some 123 (18.5%) women sought advice by telephone for a concern related to the abortion and 56 (8.4%) then attended a clinic for review. Most (628, 95%) women rated their care as very or somewhat acceptable. CONCLUSIONS This model of telemedicine abortion without routine ultrasound is safe, and has high efficacy and high acceptability among women.
Collapse
Affiliation(s)
- John Joseph Reynolds-Wright
- Queen's Medical Research Institute, University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
- NHS Lothian, Chalmers Centre, Edinburgh, UK
| | - Anne Johnstone
- Queen's Medical Research Institute, University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
- NHS Lothian, Chalmers Centre, Edinburgh, UK
| | - Karen McCabe
- Queen's Medical Research Institute, University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
- NHS Lothian, Chalmers Centre, Edinburgh, UK
| | - Emily Evans
- Edinburgh Clinical Research Facility, Edinburgh, UK
| | - Sharon Cameron
- Queen's Medical Research Institute, University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
- NHS Lothian, Chalmers Centre, Edinburgh, UK
| |
Collapse
|
22
|
The future of abortion is now: Mifepristone by mail and in-clinic abortion access in the United States. Contraception 2021; 104:38-42. [DOI: 10.1016/j.contraception.2021.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022]
|
23
|
Kerestes C, Delafield R, Elia J, Chong E, Kaneshiro B, Soon R. “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. Contraception 2021; 104:67-72. [DOI: 10.1016/j.contraception.2021.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
|
24
|
Family medicine provision of online medication abortion in three US states during COVID-19. Contraception 2021; 104:54-60. [PMID: 33939985 PMCID: PMC8086374 DOI: 10.1016/j.contraception.2021.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine provision of direct-to-patient medication abortion during COVID-19 by United States family physicians through a clinician-supported, asynchronous online service, Aid Access. STUDY DESIGN We analyzed data from United States residents in New Jersey, New York, and Washington who requested medication abortion from 3 family physicians using the online service from Aid Access between April and November 2020. This study seeks to examine individual characteristics, motivations, and geographic locations of patients receiving abortion care through the Aid Access platform. RESULTS Over 7 months, three family physicians using the Aid Access platform provided medication abortion care to 534 residents of New Jersey, New York, and Washington. There were no demographic differences between patients seeking care in these states. A high percentage (85%) were less than 7 weeks gestation at the time of their request for care. The reasons patients chose Aid Access for abortion services were similar regardless of state residence. The majority (71%) of Aid Access users lived in urban areas. Each family physician provided care to most counties in their respective states. Among those who received services in the three states, almost one-quarter (24%) lived in high Social Vulnerability Index (SVI) counties, with roughly one-third living in medium-high SVI counties (33%), followed by another quarter (26%) living in medium-low SVI counties. CONCLUSIONS Family physicians successfully provided medication abortion in three states using asynchronous online consultations and medications mailed directly to patients. IMPLICATIONS Primary care patients are requesting direct-to-patient first trimester abortion services online. By providing abortion care online, a single provider can serve the entire state, thus greatly increasing geographic access to medication abortion.
Collapse
|
25
|
Stone RH, Rafie S. Medication abortion: Advocating for mifepristone dispensing by pharmacists. Contraception 2021; 104:31-32. [DOI: 10.1016/j.contraception.2021.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
|
26
|
Boydell N, Reynolds-Wright JJ, Cameron ST, Harden J. Women's experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID-19) pandemic: a qualitative evaluation. BJOG 2021; 128:1752-1761. [PMID: 34138505 PMCID: PMC8441904 DOI: 10.1111/1471-0528.16813] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
Objective To explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks’ gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID‐19) pandemic, to identify areas for improvement and inform service provision. Design Qualitative interview study. Setting Abortion service in one National Health Service health board in Scotland. Population or sample Twenty women who accessed telemedicine abortion services and self‐administered mifepristone and misoprostol at home up to 12 weeks’ gestation. Methods Thematic analysis of semi‐structured qualitative interviews, informed by the Framework analytic approach. Main outcome measures Women’s experiences of accessing telemedicine for medical abortion at home, specifically: acceptability of the telephone consultation and remote support; views on no pre‐abortion ultrasound scan; and self‐administration of abortion medications at home. Results Novel study findings were three‐fold: (1) participants valued the option of accessing abortion care via telemedicine and emphasised the benefits of providing a choice of telephone and in‐person consultation to suit those with different life circumstances; (2) the quality of abortion care was enhanced by the telemedicine service in relation to access, comfort and flexibility, and ongoing telephone support; (3) participants described being comfortable with, and in some cases a preference for, not having an ultrasound scan. Conclusions This research demonstrates support for the continuation of telemedicine abortion services beyond the temporary arrangements in place during COVID‐19, and lends weight to the argument that offering the option of telemedicine abortion care can enable women to access this essential health service. Tweetable abstract #Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher. #Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher. This article includes Author Insights, a video abstract available at: https://vimeo.com/bjog/authorinsights16813
Collapse
Affiliation(s)
- N Boydell
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - J J Reynolds-Wright
- NHS Lothian, Edinburgh, UK.,MRC Centre for Reproductive Healthcare, University of Edinburgh, Edinburgh, UK
| | - S T Cameron
- NHS Lothian, Edinburgh, UK.,MRC Centre for Reproductive Healthcare, University of Edinburgh, Edinburgh, UK
| | - J Harden
- Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
27
|
Reynolds-Wright JJ, Norrie J, Cameron ST. UTAH: Using Telemedicine to improve early medical Abortion at Home: a protocol for a randomised controlled trial comparing face-to-face with telephone consultations for women seeking early medical abortion. BMJ Open 2021; 11:e046628. [PMID: 34135047 PMCID: PMC8211053 DOI: 10.1136/bmjopen-2020-046628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/03/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Early medical abortion (EMA) is a two-stage process of terminating pregnancy using oral mifepristone (a progesterone-receptor antagonist) followed usually 1-2 days later by sublingual, vaginal or buccal misoprostol (a prostaglandin analogue). There are no published randomised controlled trials (RCTs) on the use of telemedicine for EMA. Our proposed research will determine if telephone consultations for EMA (the most common method of abortion in the UK) is non-inferior to standard face-to-face consultations with regard to the efficacy of EMA. METHODS AND ANALYSIS This study will be conducted as an RCT. The recruitment target is 1222 participants.The primary outcome is success of EMA (complete abortion rate). This will be determined based on a negative low-sensitivity urine pregnancy test result (2 weeks after misoprostol use) and absence of surgical intervention or diagnosis of ongoing pregnancy (within 6 weeks of misoprostol).Secondary outcomes include total time spent at a clinic appointment to receive EMA, self-reported preparedness for EMA, level of satisfaction with consultation and effective contraception uptake compared with when women attend for a face-to-face consultation.The main analysis will be a modified intention-to-treat analysis. This will include all randomised women (with a viable pregnancy) using EMA and follow-up for the main outcome. The study initiated on 13 January 2020 and is anticipated to finish in late 2021. ETHICS AND DISSEMINATION Ethical approval was given by the South East Scotland NHS Research Ethics Committee, reference: 19/SS/0111. Results will be published in peer-reviewed journals, presented at clinical and academic meetings, and shared with participants via the clinic website. TRIAL REGISTRATION NUMBER NCT04139382.
Collapse
Affiliation(s)
- John Joseph Reynolds-Wright
- The Queen's Medical Research Institute, The University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
- Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Sharon Tracey Cameron
- The Queen's Medical Research Institute, The University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
- Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
28
|
Chandrasekaran S, Chandrashekar VS, Dalvie S, Sinha A. The case for the use of telehealth for abortion in India. Sex Reprod Health Matters 2021; 29:1920566. [PMID: 34078249 PMCID: PMC8183532 DOI: 10.1080/26410397.2021.1920566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
India has the world’s fastest growing outbreak of COVID-19. With limited mobility, increased reports of intimate partner violence, changes in living patterns of migrants, delays in accessing contraception and safe abortion care, and potential changes to decisions about parenting, there may be an increased need for abortion services in India due to the pandemic. The use of technology for providing abortion information and services has been well documented in global literature. The safety of abortion provision using telehealth has been established in several contexts including the United States and Australia. The importance of hotlines and other support systems that use technology to provide information and support to clients through their abortion is also highlighted in the literature. Several countries, such as the United Kingdom, France, New Zealand, and Pakistan are now allowing the use of technology for abortion/post-abortion care in light of the pandemic; however, India’s telemedicine guidelines do not include abortion. In a country where the majority of abortions take place outside the health system, allowing the use of telemedicine for abortion can help bring legality to users, and expand access to those facing additional barriers in accessing the care they deserve. We outline models for telemedicine provision of abortion in India and discuss the regulatory changes required to make telehealth for abortion a reality in India.
Collapse
Affiliation(s)
- Sruthi Chandrasekaran
- Senior Project Manager, Ibis Reproductive Health, Cambridge, MA, USA. Correspondence:
| | - V S Chandrashekar
- CEO, Foundation for Reproductive Health Services India, New Delhi, India (affiliate of MSI Reproductive Choices)
| | - Suchitra Dalvie
- Coordinator, Asia Safe Abortion Partnership, New Delhi, India
| | - Anand Sinha
- Country Advisor (India), The David and Lucile Packard Foundation, New Delhi, India
| |
Collapse
|
29
|
Wang M, Girgis M, Cohen S, Lee J. Complications of abortion and need for appropriate ultrasound assessment and peri-abortion care. Aust N Z J Obstet Gynaecol 2021; 61:607-611. [PMID: 33872380 DOI: 10.1111/ajo.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
Abortion is an essential medical service; however, the lack of standardised protocols and follow-up can cause unintended harm. We present four cases of post-abortion complications presenting to a Sydney tertiary hospital which could have been avoided by appropriate ultrasound prior to abortion and peri-abortion care. While social progress has led to significant reforms in abortion law, clinical guidelines must also be updated and consistently applied to ensure safety of this practice.
Collapse
Affiliation(s)
- Mandy Wang
- Department of Women's and Newborn Health, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Myriam Girgis
- Department of Gynaecology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sally Cohen
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Joseph Lee
- Department of Gynaecology, St Vincent's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
30
|
McCloskey L, Amutah-Onukagha N, Bernstein J, Handler A. Setting the Agenda for Reproductive and Maternal Health in the Era of COVID-19: Lessons from a Cruel and Radical Teacher. Matern Child Health J 2021; 25:181-191. [PMID: 33411108 PMCID: PMC7788380 DOI: 10.1007/s10995-020-03033-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND COVID-19 exposes major gaps in the MCH safety net and illuminates the disproportionate consequences borne by people living in low resource communities where systemic racism, community disinvestment, and social marginalization creates a perfect storm of vulnerability. METHODS We draw eight lessons from the first 8 months of the pandemic, describing how COVID-19 has intensified pre-existing gaps in the MCH support network and created new problems. For each lesson identified, we present supporting evidence and a call for specific actions that can be taken by MCH practitioners, researchers and advocates. RESULTS LESSON #1: COVID-19 hits communities of color hardest, exposing and exacerbating health inequities caused by systemic racism. LESSON #2: Women experience the most devastating social, economic and mental health tolls during COVID-19. LESSON #3: Virulent pathogens find and exacerbate cracks in our public health and health care systems. LESSON #4: COVID-19 has become a pretext to limit access to sexual and reproductive health care. LESSON #5: COVID-19 has exposed and deepened fault lines in maternity care: over-medicalization, discrimination, lack of workforce diversity, underutilization of collaborative team approaches, and lack of post-delivery follow-up. LESSON #6: The pandemic adds impetus to much-needed Medicaid policy reforms that can have a lasting positive effect on maternal health. LESSON #7: Social and health policy changes, heretofore deemed infeasible, ARE possible under pandemic threat. LESSON #8: Finally, an overarching COVID-19 lesson: We are all inextricably connected. CONCLUSION COVID-19 is a loud wake up call for renewed action by MCH epidemiologists, policy-makers, and advocates.
Collapse
Affiliation(s)
- Lois McCloskey
- Department of Community Health Sciences, Center of Excellence in Maternal and Child Health Education, Science and Practice, Boston University School of Public Health, 801 Massachusetts Avenue | CT 436 |, Boston, MA 02118 USA
| | | | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 USA
| | - Arden Handler
- Division of Community Health Sciences and Center of Excellence in Maternal and Child Health, University of Illinois School of Public Health, 1603 W. Taylor, Chicago, IL 60612 USA
| |
Collapse
|
31
|
Cashman C, Downing SG, Russell D. Women's experiences of accessing a medical termination of pregnancy through a Queensland regional sexual health service: a qualitative study. Sex Health 2021; 18:232-238. [PMID: 33985645 DOI: 10.1071/sh20220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/12/2021] [Indexed: 11/23/2022]
Abstract
Background An estimated 25% of Australian women will undergo induced abortion. Few studies have explored Australian women's experiences of accessing medical termination of pregnancy (MToP). This study explored the experiences of women accessing MToP through a regional sexual health service in North Queensland. It aimed to determine the aspects of the process from seeking information about abortion to completion that worked well and to identify areas for improvement. METHODS Semi-structured telephone interviews with 11 women who accessed MTOP at Cairns Sexual Health Service (CSHS) were conducted. Interviews were recorded and transcribed verbatim. A deductive analysis approach was used to analyse the data. RESULTS Most women had little prior knowledge of MToP or access options and used the Internet to source information. Accessing MToP through a sexual health service was considered positive, non-judgemental, discrete and low-cost despite challenges of fitting in with appointment times and obtaining off-site ultrasound. GPs did not always provide referral; some women described experiences of stigma, discrimination and judgemental care during consultation and when obtaining ultrasounds. Concern for women living in more rural/remote areas was raised. Potential solutions including increased provision through rural general practitioners (GPs) and telehealth. CONCLUSION Our study highlights the need for greater awareness of abortion options and access points among the community and healthcare providers. Access through sexual health clinics in regional settings is accepted; however, other options such as increased provision through rural GPs, primary health clinics, telehealth and nurse-led models of care could help overcome some of the barriers faced by rural and remote women.
Collapse
Affiliation(s)
- Colette Cashman
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Qld, Australia; and Corresponding author.
| | - Sandra G Downing
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Qld, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns, Qld 4870, Australia
| |
Collapse
|
32
|
Endler M, Cleeve A, Lavelanet A, Gemzell-Danielsson K. The use of telemedicine services for medical abortion. Hippokratia 2020. [DOI: 10.1002/14651858.cd013764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Margit Endler
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Amanda Cleeve
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research; World Health Organization; Geneva Switzerland
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
33
|
Melville C. Digital provision of sexual and reproductive healthcare: promising but not a panacea. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:239-241. [PMID: 32883684 DOI: 10.1136/bmjsrh-2020-200668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
|
34
|
Mazza D, Deb S, Subasinghe A. Telehealth: an opportunity to increase access to early medical abortion for Australian women. Med J Aust 2020; 213:298-299.e1. [PMID: 32951196 DOI: 10.5694/mja2.50782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
35
|
Murdoch J, Thompson K, Belton S. Rapid uptake of early medical abortions in the Northern Territory: A family planning-based model. Aust N Z J Obstet Gynaecol 2020; 60:970-975. [PMID: 32909248 DOI: 10.1111/ajo.13240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Abortion law reform does not necessarily translate into services, especially for those in regional areas. Although abortion has been legal in the Northern Territory (NT) since 1974, prior to 2017 legislation change, early medical abortions (EMAs) were effectively prohibited in primary care. In July 2017, Family Planning Welfare Association of the Northern Territory (FPNT) was awarded funding to provide EMAs free of charge for Medicare eligible clients. AIMS To describe the demographics and clinical outcomes of clients accessing the EMA service in the first 12 months after legislation change. MATERIALS AND METHODS Retrospective audit of FPNT's Unplanned Pregnancy Database from 1 July 2017 to 30 June 2018 and analysis of the NT Government's Termination of Pregnancy 12 Month Data Report. RESULTS Of 742 abortions in the NT in the first 12 months after legislation change, 426 were EMAs prescribed at FPNT. Eleven percent of these (47/426) were for Aboriginal or Torres Strait Islander women and 15% (64/426) were for women from Remote or Very Remote Australia. Outcomes were definitively documented for 326 (77%); 5% of these required further misoprostol and 99% had a complete abortion without surgical intervention. Eighty-six percent (281/326) commenced effective hormonal contraception following their EMA. CONCLUSIONS Providing funding to a Family Planning service was effective in devolving the majority of abortions from tertiary to primary healthcare and increasing the use of effective contraception. Some women remain under-represented, particularly women from more remote areas of the NT. Further work is required to ensure equity of access to services for these women.
Collapse
Affiliation(s)
- Jacqueline Murdoch
- Clinical Division, Family Planning Welfare Association of the Northern Territory, Darwin, Northern Territory, Australia
| | - Kirsten Thompson
- Clinical Division, Family Planning Welfare Association of the Northern Territory, Darwin, Northern Territory, Australia
| | - Suzanne Belton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| |
Collapse
|
36
|
Abstract
Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. The U.S. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. The purpose of this document is to provide updated evidence-based guidance on the provision of medication abortion up to 70 days (or 10 weeks) of gestation. Information about medication abortion after 70 days of gestation is provided in other ACOG publications [1].
Collapse
|
37
|
|
38
|
Fix L, Seymour JW, Sandhu MV, Melville C, Mazza D, Thompson TA. At-home telemedicine for medical abortion in Australia: a qualitative study of patient experiences and recommendations. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:172-176. [PMID: 32665231 DOI: 10.1136/bmjsrh-2020-200612] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION This study aimed to explore patient experiences obtaining a medical abortion using an at-home telemedicine service operated by Marie Stopes Australia. METHODS From July to October 2017, we conducted semistructured in-depth telephone interviews with a convenience sample of medical abortion patients from Marie Stopes Australia. We analysed interview data for themes relating to patient experiences prior to service initiation, during an at-home telemedicine medical abortion visit, and after completing the medical abortion. RESULTS We interviewed 24 patients who obtained care via the at-home telemedicine medical abortion service. Patients selected at-home telemedicine due to convenience, ability to remain at home and manage personal responsibilities, and desires for privacy. A few telemedicine patients reported that a lack of general practitioner knowledge of abortion services impeded their access to care. Most telemedicine patients felt at-home telemedicine was of equal or superior privacy to in-person care and nearly all felt comfortable during the telemedicine visit. Most were satisfied with the home delivery of the abortion medications and would recommend the service. CONCLUSION Patient reports suggest that an at-home telemedicine model for medical abortion is a convenient and acceptable mode of service delivery that may reduce patient travel and out-of-pocket costs. Additional provider education about this model may be necessary in order to improve continuity of patient care. Further study of the impacts of this model on patients is needed to inform patient care and determine whether such a model is appropriate for similar geographical and legal contexts.
Collapse
Affiliation(s)
- Laura Fix
- Ibis Reproductive Health, Cambridge, Massachusetts, United States
| | - Jane W Seymour
- Ibis Reproductive Health, Cambridge, Massachusetts, United States
| | | | | | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | | |
Collapse
|
39
|
Parsons JA. 2017–19 governmental decisions to allow home use of misoprostol for early medical abortion in the UK. Health Policy 2020; 124:679-683. [DOI: 10.1016/j.healthpol.2020.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/21/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
|
40
|
Thompson TA, Sonalkar S, Butler JL, Grossman D. Telemedicine for Family Planning: A Scoping Review. Obstet Gynecol Clin North Am 2020; 47:287-316. [PMID: 32451019 PMCID: PMC10093687 DOI: 10.1016/j.ogc.2020.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Telemedicine has the potential to increase access to family planning. The most common application involved the use of text message reminders and mobile apps. Text messaging increased knowledge in a variety of settings, but had no effect on contraceptive uptake and use. Two randomized studies found that text messaging improved continuation of oral contraceptives and injectables. Telemedicine provision of medication abortion included both clinic-to-clinic and direct-to-patient models of care. Telemedicine provision of medication abortion has been found to be equally safe and effective as in-person provision. Some measures of satisfaction are higher with telemedicine. Telemedicine may improve access to early abortion.
Collapse
Affiliation(s)
- Terri-Ann Thompson
- Ibis Reproductive Health, 2067 Massachusetts Avenue, Suite 320, Cambridge, MA 02140, USA.
| | - Sarita Sonalkar
- Department of Obstetrics and Gynecology, University of Pennsylvania, 1000 Courtyard, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jessica L Butler
- The American College of Obstetricians and Gynecologists, 409 12th Street, Southwest, PO Box 96920, Washington, DC 20090-6920, USA
| | - Daniel Grossman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA. https://twitter.com/DrDGrossman
| |
Collapse
|
41
|
Baird B, Millar E. Abortion at the edges: Politics, practices, performances. WOMENS STUDIES INTERNATIONAL FORUM 2020; 80:102372. [PMID: 32346206 PMCID: PMC7186192 DOI: 10.1016/j.wsif.2020.102372] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022]
Abstract
This article provides a brief overview of the state of discourse, politics and provision of abortion in the Anglophone West, including developments in the wake of the COVID-19 pandemic. It then surveys three promising directions for feminist abortion scholarship. The first is work inspired by the Reproductive Justice Movement, that points to the intersectional axes of inequality that shape abortion discourse and position us in relation to reproductive choice and access issues. The second is work that examines the particularity of the constitution of the aborting body, reflecting the particularity of the pregnant body. This is a specific body, with a specific history; abortion discourse draws from and makes a significant contribution to the meaning and lived experience of this body. The third area of scholarship we highlight is that which seeks to amplify the meaning of abortion as a social good. Much abortion scholarship is attuned to a critique of negative aspects of abortion-from its representation in popular culture to restrictive law and access issues. This is critical work but/and the performative nature of abortion scholarship, like all discourse, means that it can amplify the association of negativity with abortion. The article concludes by introducing the articles contained in the special section of Women's Studies International Forum, 'Abortion at the edges: Politics, practices, performances'.
Collapse
Affiliation(s)
- Barbara Baird
- Women's Studies, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| | - Erica Millar
- Crime, Justice and Legal Studies, La Trobe University, Bundoora, Victoria 3086, Australia
| |
Collapse
|
42
|
Raymond EG, Grossman D, Mark A, Upadhyay UD, Dean G, Creinin MD, Coplon L, Perritt J, Atrio JM, Taylor D, Gold M. Commentary: No-test medication abortion: A sample protocol for increasing access during a pandemic and beyond. Contraception 2020; 101:361-366. [PMID: 32305289 PMCID: PMC7161512 DOI: 10.1016/j.contraception.2020.04.005] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/05/2022]
Affiliation(s)
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, CA, United States.
| | - Alice Mark
- National Abortion Federation, Washington DC, United States.
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, CA, United States.
| | - Gillian Dean
- Planned Parenthood Federation of America, New York, NY, United States.
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States.
| | - Leah Coplon
- Maine Family Planning, Augusta, ME, United States.
| | - Jamila Perritt
- Reproductive Health and Family Planning Specialist, Washington DC, United States
| | - Jessica M Atrio
- Society of Family Planning, Clinical Affairs Subcommittee and Department of Obstetrics and Gynecology, Montefiore Hospital and Albert Einstein College of Medicine, Bronx, NY, United States.
| | - DeShawn Taylor
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine Phoenix, AZ, United States.
| | - Marji Gold
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, United States.
| |
Collapse
|
43
|
LaRoche KJ, Wynn L, Foster AM. “We’ve got rights and yet we don’t have access”: Exploring patient experiences accessing medication abortion in Australia. Contraception 2020; 101:256-260. [DOI: 10.1016/j.contraception.2019.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 11/12/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
|
44
|
Kerestes C, Sheets K, Stockdale CK, Hardy-Fairbanks AJ. Prevalence, attitudes and knowledge of misoprostol for self-induction of abortion in women presenting for abortion at Midwestern reproductive health clinics. Sex Reprod Health Matters 2020; 27:1571311. [PMID: 31533561 PMCID: PMC7887767 DOI: 10.1080/09688080.2019.1571311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In the setting of increasing restrictions to legal abortion in the United States, reports have emerged of self-induced termination of pregnancies with misoprostol, obtained without a prescription or provider. This study seeks to describe the prevalence of women seeking or employing misoprostol for self-induced abortion, and how they access information. In a cross-sectional study of women immediately following their abortion at three reproductive health clinics in the Midwestern United States, an anonymous survey queried gestational age, barriers, online investigation about self-induction and opinions concerning the availability of medical abortion. From June to September 2016, 276 women participated out of 437 presenting to the clinics during the study period. One hundred and ninety-one (74.6%) women had investigated abortion options online, and of those, 58 (30.9%) investigated misoprostol online, for home use. Women who investigated online options were less likely to have had a prior abortion than those who did not investigate online (29.3% vs. 63.1%, p < .01). They were also more likely to report prior home attempts to end this pregnancy (8.6% vs. 0%, p = .05). Overall, four (1.6%) of the respondents purchased misoprostol and three (1.2%) used it. A majority of women seeking an abortion sought online information prior to their clinic appointment, and almost a third of those had investigated misoprostol for home use. Women are accessing information regarding misoprostol for self-induction of abortion on the Internet. As barriers to legal abortion increase, women may be more likely to self-induce abortion.
Collapse
Affiliation(s)
- Courtney Kerestes
- Resident Physician, Department of Obstetrics and Gynecology , University of Iowa Hospitals and Clinics , Iowa City , IA , USA
| | - Kelsey Sheets
- Medical student/researcher, University of Iowa Carver College of Medicine , Iowa City , IA , USA
| | - Colleen K Stockdale
- Clinical Professor, Department of Obstetrics and Gynecology , University of Iowa Hospitals and Clinics , Iowa City , IA , USA
| | - Abbey J Hardy-Fairbanks
- Associate Clinical Professor, Department of Obstetrics and Gynecology , University of Iowa Hospitals and Clinics , Iowa City , IA , USA
| |
Collapse
|
45
|
de Moel-Mandel C, Graham M. Medical abortion: it is time to lift restrictions. Med J Aust 2019; 211:428-428.e1. [PMID: 31625140 DOI: 10.5694/mja2.50363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
46
|
Dion S, Wiebe E, Kelly M. Quality of care with telemedicine for medical assistance in dying eligibility assessments: a mixed-methods study. CMAJ Open 2019; 7:E721-E729. [PMID: 31836629 PMCID: PMC6910140 DOI: 10.9778/cmajo.20190111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To facilitate access to medical assistance in dying (MAiD) in British Columbia, telemedicine has been used for eligibility assessments. This research explored the impacts of using telemedicine on quality of care. METHODS This mixed-methods study consisted of data from 3 BC health authorities and semistructured interviews with a patient, support persons, providers and administrators about the use of telemedicine for MAiD eligibility assessment. Interviews were conducted by telephone, video meeting or email between June and November 2018. We analyzed the quantitative data using descriptive statistics. We categorized the qualitative data using the 7 dimensions of the BC Health Quality Matrix and then analyzed them qualitatively with abductive coding. RESULTS Twenty-one participants (8 MAiD assessors, 1 patient, 7 support persons of patients and 5 MAiD administrators) were interviewed. Telemedicine for MAiD eligibility assessments was highly acceptable to the support persons and patient and to most assessors and administrators. Assessors expressed challenges with empathy, eye contact, nonverbal communication and missing contextual factors. Participants described which patients were appropriate and which were not. Telemedicine improved access and equity for the patients who received this service. It was perceived as an effective and efficient way to perform eligibility assessments. Concerns were expressed by assessors and administrators, but not by the patient or support persons, about confidentiality. Opinions varied on the requirement for a regulated health care professional to be in physical attendance with the patient to act as a witness. INTERPRETATION Quality of care can be achieved with telemedicine for MAiD eligibility assessments for specific situations and patients, and this modality has the potential to expand access to MAiD. Updated clinical and administrative policies are needed to address barriers to telemedicine access and to best support patients and assessors using this technology.
Collapse
Affiliation(s)
- Stephanie Dion
- School of Public Health (Dion) and Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK
| | - Ellen Wiebe
- School of Public Health (Dion) and Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK
| | - Michaela Kelly
- School of Public Health (Dion) and Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK
| |
Collapse
|
47
|
Raymond E, Chong E, Winikoff B, Platais I, Mary M, Lotarevich T, Castillo PW, Kaneshiro B, Tschann M, Fontanilla T, Baldwin M, Schnyer A, Coplon L, Mathieu N, Bednarek P, Keady M, Priegue E. TelAbortion: evaluation of a direct to patient telemedicine abortion service in the United States. Contraception 2019; 100:173-177. [DOI: 10.1016/j.contraception.2019.05.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
|
48
|
Finch RE, McGeechan K, Johnstone A, Cameron S. Impact of self-administration of misoprostol for early medical abortion: a prospective observational cohort study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200278. [PMID: 31422346 DOI: 10.1136/bmjsrh-2018-200278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/16/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In October 2017, Scotland legalised the home use of misoprostol for the purpose of early medical abortion (EMA). Women up to 9+6 weeks' gestation can now self-administer the drug at home, 24-48 hours after receiving mifepristone in the clinic. OBJECTIVE To evaluate the impact of this change on the uptake and success rate of EMA, and on the provision of effective contraception on discharge. METHODS A prospective observational study was conducted to compare the outcomes of two cohorts of women in the 6 months before and 6 months after the introduction of home administration of misoprostol. The main outcome measures were uptake of EMA, success of EMA and provision of long-acting reversible contraception (LARC) to women undergoing EMA. RESULTS There was a statistically significant increase in the uptake of EMA from 698/1075 (64.9%) women in the first study period to 823/1146 (71.8%) in the second study period. There was no statistically significant difference in the success rate of EMA: 99.3% and 98.9% in clinic and home misoprostol cohorts, respectively. There was also no statistically significant difference in the proportion of women provided with LARC: 37.7% and 33.7% in clinic and home misoprostol cohorts, respectively. CONCLUSIONS Self-administration of misoprostol at home increased uptake of EMA, with no effect on the high success rate that was previously seen with clinic administration of misoprostol. In addition, the reduced number of visits associated with home use of misoprostol has not affected the provision of effective contraception to women.
Collapse
Affiliation(s)
| | - Kevin McGeechan
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sharon Cameron
- Department of Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
- University of Edinburgh Division of Health Sciences, Edinburgh, UK
| |
Collapse
|
49
|
Kerestes CA, Stockdale CK, Zimmerman MB, Hardy-Fairbanks AJ. Abortion providers' experiences and views on self-managed medication abortion: an exploratory study. Contraception 2019; 100:160-164. [PMID: 31002777 DOI: 10.1016/j.contraception.2019.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Data on the practice of self-managed medication abortion are limited, in part because this practice takes place purposefully outside of established healthcare systems. Given this, we aimed to ascertain abortion providers' familiarity with self-managed medication abortion and associated complications, compare regional differences and evaluate provider attitudes. STUDY DESIGN We distributed an online survey to members of Society for Family Planning, Association of Reproductive Health Providers and the Abortion Care Network between July and September 2017 querying experiences with and opinions about self-managed abortion. RESULTS Of 650 respondents, 359 (55.1%) were direct abortion providers. Two hundred and thirty of 335 providers (68.6%) had experience with women trying to interrupt pregnancies on their own, and of those, 153 (76.1%) had seen use of misoprostol and/or mifepristone, and 204 of 342 (59.6%) thought this practice increased in the past 5 years. One hundred and seventeen of 335 (34.9%), witnessed complications from self-managed abortion with misoprostol/mifepristone, most commonly incomplete abortion and less often hemorrhage, sepsis and uterine rupture. Half of providers, 171 of 321 (53.3%), think that the use of misoprostol/mifepristone for the self-management of abortion is safe. CONCLUSION Two thirds of respondents had experiences with women attempting to self-manage abortion, and about a third witnessed complications related to self-managed medication abortion. About half of respondents agreed that self-managed abortion is safe. IMPLICATIONS This study establishes that self-managed abortion is a practice which a majority of respondents have seen among their patients and, because of its prevalence, an area that warrants further research.
Collapse
Affiliation(s)
- Courtney A Kerestes
- University of Iowa Hospitals and Clinics, Department of Obstetrics and Gynecology, 200 Hawkins Drive, Iowa City, IA, 52242.
| | - Colleen K Stockdale
- University of Iowa Hospitals and Clinics, Department of Obstetrics and Gynecology, 200 Hawkins Drive, Iowa City, IA, 52242
| | - M Bridget Zimmerman
- University of Iowa Department of Public Health, Biostatistics Counseling Center, 145 N Riverside Dr., Iowa City, IA 52246
| | - Abbey J Hardy-Fairbanks
- University of Iowa Hospitals and Clinics, Department of Obstetrics and Gynecology, 200 Hawkins Drive, Iowa City, IA, 52242
| |
Collapse
|
50
|
Abstract
PURPOSE OF REVIEW Medical abortion offers a well tolerated and effective method to terminate early pregnancy, but remains underutilized in the United States. Over the last decade, 'telemedicine' has been studied as an option for medical abortion to improve access when patients and providers are not together. A number of studies have explored various practice models and their feasibility as an alternative to in-person service provision. RECENT FINDINGS A direct-to-clinic model of telemedicine medical abortion has similar efficacy with no increased risk of significant adverse events when compared with in-person abortion. A direct-to-consumer model is currently being studied in the United States. International models of direct-to-consumer medical abortion have shown promising results. SUMMARY The introduction of telemedicine into abortion care has been met with early success. Currently, there are limitations to the reach of telemedicine because of specific restrictions on mifepristone in the United States as well as laws that specifically prohibit telemedicine for abortion. If these barriers are removed, telemedicine can potentially increase abortion access.
Collapse
|