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Merz-Herrala AA, Kerns JL, Logan R, Gutierrez S, Marshall C, Diamond-Smith N. Contraceptive care in the United States during the COVID-19 pandemic: A social media survey of contraceptive access, telehealth use and telehealth quality. Contraception 2023; 123:110000. [PMID: 36871620 PMCID: PMC9985539 DOI: 10.1016/j.contraception.2023.110000] [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: 10/09/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To examine demographic, socioeconomic, and regional differences in contraceptive access, differences between telehealth and in-person contraception visits, and telehealth quality in the United States during the COVID-19 pandemic. STUDY DESIGN We surveyed reproductive-age women about contraception visits during the COVID-19 pandemic via social media in July 2020 and January 2021. We used multivariable regression to examine relationships between age, racial/ethnic identity, educational attainment, income, insurance type, region, and COVID-19 related hardship, and ability to obtain a contraceptive appointment, telehealth vs in-person visits, and telehealth quality scores. RESULTS Among 2031 respondents seeking a contraception visit, 1490 (73.4%) reported any visit, of which 530 (35.6%) were telehealth. In adjusted analyses, lower odds of any visit was associated with Hispanic/Latinx and Mixed race/Other identity (aOR 0.59 [0.37-0.94], aOR 0.36 [0.22-0.59], respectively), the South, Midwest, Northeast (aOR 0.63 [0.47-0.85], aOR 0.64 [0.46-0.90], aOR 0.52 [CI 0.36-0.75], respectively), no insurance (aOR 0.63 [0.43-0.91]), greater COVID-19 hardship (aOR 0.52 [0.31-0.87]), and earlier pandemic timing (January 2021 vs July 2020 aOR 2.14 [1.69-2.70]). Respondents from the Midwest and South had lower odds of telehealth vs in-person care (aOR 0.63 [0.44-0.88], aOR 0.54 [0.40-0.72], respectively). Hispanic/Latinx respondents and those in the Midwest had lower odds of high telehealth quality (aOR 0.37 [0.17-0.80], aOR 0.58 [0.35-0.95], respectively). CONCLUSIONS We found inequities in contraceptive care access, less telehealth use for contraception visits in the South and Midwest, and lower telehealth quality among Hispanic/Latinx people during the COVID-19 pandemic. Future research should focus on telehealth access, quality, and patients' preferences. IMPLICATIONS Historically marginalized groups have faced disproportionate barriers to contraceptive care, and telehealth for contraceptive care has not been employed equitably during the COVID-19 pandemic. Though telehealth has the potential to improve access to care, inequitable implementation could exacerbate existing disparities.
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Affiliation(s)
- Allison A Merz-Herrala
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States.
| | - Jennifer L Kerns
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States
| | - Rachel Logan
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States
| | - Sirena Gutierrez
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
| | - Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Nadia Diamond-Smith
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
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Stifani BM, Smith A, Avila K, Levi EE, Benfield NC. Telemedicine for Contraceptive Counseling During the COVID-19 Pandemic: Referral Patterns and Attendance at Follow-Up Visits. Telemed J E Health 2022; 28:1517-1524. [DOI: 10.1089/tmj.2021.0498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bianca M. Stifani
- Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Abigail Smith
- Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Karina Avila
- Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Erika E. Levi
- Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Nerys C. Benfield
- Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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3
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Beardsworth KM, Doshi U, Raymond E, Baldwin MK. Miles and days until medical abortion via TelAbortion versus clinic in Oregon and Washington, USA. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:e38-e43. [PMID: 33789954 DOI: 10.1136/bmjsrh-2020-200972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/01/2021] [Accepted: 03/15/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Medical abortion provided via telemedicine is becoming more widely available, potentially decreasing travel time for in-person abortion evaluation. METHODS We conducted a retrospective chart review of all outpatient medical abortions from October 2016 through December 2019 at our academic medical centre in Portland, Oregon, USA. Using mifepristone administration logs, we identified patients who underwent abortion via direct-to-patient telemedicine or in clinic. Both groups had pre-abortion ultrasound examination. We extracted patient characteristics and geographic data to compare travel distance to clinic, ultrasound facility, and nearest advertised abortion clinic. We compared time from first contact until mifepristone ingestion and gestational age at mifepristone ingestion. RESULTS Median distance from mailing address to clinic for 80 telemedicine and 124 clinic medical abortions was 95 (range 4-377) and 12 (range 0-184) miles (p<0.01). Distance travelled to ultrasound facility was shorter for telemedicine patients (median 7 miles, range 0-150 vs 12 miles, range 0-184; p<0.01) excluding outliers >200 miles. Distance to nearest advertised abortion clinic was equal between groups (median 7 miles, p=0.4). Time to mifepristone administration (ingestion) was longer (11 vs 6 days; p<0.01) and median gestational age was higher (49 vs 44 days; p=0.01) for telemedicine. CONCLUSIONS Telemedicine increases the reach of abortion providers and provides care to more geographically distant patients. Patients chose telemedicine abortion even when they had an equidistant option, suggesting that patients value telemedicine for reasons other than geographic convenience. This telemedicine delivery model that included ultrasound testing prior to abortion resulted in up to a 5-day delay in abortion initiation, which was not clinically significant.
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Affiliation(s)
| | - Uma Doshi
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Maureen K Baldwin
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
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Stifani BM, Smith A, Avila K, Boos EW, Ng J, Levi EE, Benfield NC. Telemedicine for contraceptive counseling: Patient experiences during the early phase of the COVID-19 pandemic in New York City. Contraception 2021; 104:254-261. [PMID: 33861981 PMCID: PMC8056642 DOI: 10.1016/j.contraception.2021.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE During theCOVID-19 pandemic, many clinicians increased provision of telemedicine services. This study describes patient experiences with telemedicine for contraceptive counseling during the COVID-19 pandemic in New York City. STUDY DESIGN This is a mixed-methods study which includes a web-based or phone survey and in-depth phone interviews with patients who had telemedicine visits for contraception. RESULTS A total of 169 patients had eligible telemedicine visits between April 1 and June 30, 2020. Of these, 86 (51%) responded to the survey, and 23 (14%) participated in the interviews. We found that 86% of survey respondents were very satisfied with the telemedicine visit, and 63% said it completely met their needs. A majority (73%) strongly agreed that these visits should be maintained after the COVID-19 pandemic, and half (51%) would be very likely to choose them over in-person visits. In-depth interviews highlighted the convenience of telemedicine, especially for those with work or parenting responsibilities. Although some patients had in-person visits after telehealth, many appreciated the counseling they received remotely, and found the subsequent in-person visits more efficient. Patients identified visits that do not require physical exams as ideal visits for telehealth, and some hoped that all or most of their future visits would be telehealth visits. Many patients (43%) expressed a preference for phone over video visits. CONCLUSIONS Patients reported an overall positive experience with telemedicine visits for contraceptive counseling during the COVID-19 pandemic. They appreciated the convenience of telemedicine visits and valued the virtual counseling experience. IMPLICATIONS Health care providers who initiated or expanded telemedicine services for contraceptive counseling during the COVID-19 pandemic should consider continuing to offer them after the pandemic. At the policy level, these findings favor expanding access to telemedicine and providing reimbursement for virtual visits, including telephone visits.
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Affiliation(s)
- Bianca M Stifani
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States.
| | - Abigail Smith
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Karina Avila
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Elise W Boos
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - June Ng
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Erika E Levi
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
| | - Nerys C Benfield
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States
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Assifi AR, Kang M, Sullivan EA, Dawson AJ. Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence. PLoS One 2020; 15:e0242015. [PMID: 33166365 PMCID: PMC7652292 DOI: 10.1371/journal.pone.0242015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022] Open
Abstract
Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.
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Affiliation(s)
- Anisa R. Assifi
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Melissa Kang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Elizabeth A. Sullivan
- Office of the PVC Health and Medicine, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Angela J. Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
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6
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Fulcher IR, Neill S, Bharadwa S, Goldberg AB, Janiak E. State and federal abortion restrictions increase risk of COVID-19 exposure by mandating unnecessary clinic visits. Contraception 2020; 102:385-391. [PMID: 32905791 PMCID: PMC7474961 DOI: 10.1016/j.contraception.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/03/2022]
Abstract
Objective To quantify the number of medically unnecessary clinical visits and in-clinic contacts monthly caused by US abortion regulations. Study Design We estimated the number of clinical visits and clinical contacts (any worker a patient may come into physical contact with during their visit) under the current policy landscape, compared to the number of visits and contacts if the following regulations were repealed: (1) State mandatory in-person counseling visit laws that necessitate two visits for abortion, (2) State mandatory-ultrasound laws, (3) State mandates requiring the prescribing clinician be present during mifepristone administration, (4) Federal Food and Drug Administration Risk Evaluation and Mitigation Strategy for mifepristone. If these laws were repealed, “no-test” telemedicine abortion would be possible for some patients. We modeled the number of visits averted if a minimum of 15 percent or a maximum of 70 percent of medication abortion patients had a “no-test” telemedicine abortion. Results We estimate that 12,742 in-person clinic visits (50,978 clinical contacts) would be averted each month if counseling visit laws alone were repealed, and 31,132 visits (142,910 clinical contacts) would be averted if all four policies were repealed and 70 percent of medication abortion patients received no-test telemedicine abortions. Over 2 million clinical contacts could be averted over the projected 18-month COVID-19 pandemic. Conclusion Medically unnecessary abortion regulations result in a large number of excess clinical visits and contacts. Policy Implications Repeal of medically unnecessary state and federal abortion restrictions in the United States would allow for evidence-based telemedicine abortion care, thereby lowering risk of SARS-CoV-2 transmission.
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Affiliation(s)
- Isabel R Fulcher
- Harvard Medical School, Department of Global Health and Social Medicine, 641 Huntington Avenue, Boston, MA 02115, United States.
| | - Sara Neill
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, 75 Francis Street, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Sonya Bharadwa
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Alisa B Goldberg
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, 75 Francis Street, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Elizabeth Janiak
- Brigham & Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, 75 Francis Street, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
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7
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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]
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8
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Betstadt SJ, Heyrana KJ, Whaley NS. Telemedicine for Medication Abortion: The Time Is Now. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020. [DOI: 10.1007/s13669-020-00283-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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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]
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10
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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]
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Fuentes L, Jerman J. Distance Traveled to Obtain Clinical Abortion Care in the United States and Reasons for Clinic Choice. J Womens Health (Larchmt) 2019; 28:1623-1631. [PMID: 31282804 PMCID: PMC6919239 DOI: 10.1089/jwh.2018.7496] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Greater distance to abortion facilities is associated with greater out-of-pocket costs, emergency room follow-up care, negative mental health, and delayed care among U.S. abortion patients. However, the distance U.S. abortion patients travel has not been reported since 2008, and no study has examined reasons abortion patients choose the particular facility where they obtain their abortion. Materials and Methods: We analyzed data from the 2014 Abortion Patient Survey and Abortion Provider Census to report abortion patients' one-way travel from their resident zip code to their abortion clinic, whether they went to the closest clinic, and reasons for facility choice. We report unadjusted and adjusted associations of patients' characteristics with travel distance and differences in average travel distance by abortion patients' reported reasons for choosing their facility. Results: In 2014, 65% of abortion patients traveled less than 25 miles one-way, 17% traveled 25–49 miles, and 18% traveled more than 50 miles. Abortion patients who were white, college-educated, U.S.-born, ≥12 weeks pregnant, and lived outside metropolitan areas were more likely to travel farther. Nearly half of abortion patients went to their nearest provider and 32% chose their facility because it was the closest. Conclusion: These results indicate that travel distance is an important determinant of abortion care access in the United States. Nearly, one-fifth of U.S. abortion patients traveled more than 50 miles one-way and the most common reason reported for clinic choice was that it was the closest.
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Affiliation(s)
- Liza Fuentes
- Research Division, Guttmacher Institute, New York, New York
| | - Jenna Jerman
- Research Division, Guttmacher Institute, New York, New York
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12
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Aiken ARA, Broussard K, Johnson DM, Padron E. Motivations and Experiences of People Seeking Medication Abortion Online in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:157-163. [PMID: 29992793 PMCID: PMC8256438 DOI: 10.1363/psrh.12073] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 05/16/2023]
Abstract
CONTEXT State legislation restricting access to abortion in the clinic setting raises the possibility that an increasing number of individuals in the United States will self-manage their abortion at home. Medications sourced online represent a potential pathway to abortion self-management. Yet, very little is known about the reasons U.S. residents may seek abortion online or their experiences finding medications and information. METHODS In January-June 2017, anonymous in-depth interviews were conducted with 32 people from 20 states who sought abortion medications online (30 women and two men seeking medications for their partners). Participants were asked about their (or their partners') motivations for considering self-managed abortion, the sources of medications they identified and any other methods they considered. Transcripts were coded and analyzed according to the principles of grounded theory. RESULTS The analysis revealed four key themes: Seeking abortion medications online can be a response to clinic access barriers both in states with and in ones without restrictive abortion laws; self-managed abortion can be a preference over clinical care; online options offer either information or medications, but not both; and the lack of trusted online options can delay care and lead to consideration of ineffective or unsafe alternatives. CONCLUSION Current online options for abortion medications leave many important needs unmet, particularly for women who encounter barriers to obtaining clinic-based abortion services. There is a public health justification to reduce clinic access barriers and to make medication abortion that is sourced online and managed at home as safe and supported as possible.
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Affiliation(s)
- Abigail R A Aiken
- Assistant professor, LBJ School of Public Affairs, and faculty research associate, Population Research Center, University of Texas at Austin
| | - Kathleen Broussard
- Graduate student, Department of Sociology, and graduate research trainee, Population Research Center, University of Texas at Austin
| | - Dana M Johnson
- Graduate student, LBJ School of Public Affairs, University of Texas at Austin
| | - Elisa Padron
- Undergraduate student, College of Natural Sciences, University of Texas at Austin
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13
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Aiken ARA, Guthrie KA, Schellekens M, Trussell J, Gomperts R. Barriers to accessing abortion services and perspectives on using mifepristone and misoprostol at home in Great Britain. Contraception 2018; 97:177-183. [PMID: 28941978 PMCID: PMC5801070 DOI: 10.1016/j.contraception.2017.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available. STUDY DESIGN We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help. RESULTS Over a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control. CONCLUSION Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks. IMPLICATIONS The presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in controlling circumstances are particularly important goals.
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Affiliation(s)
- Abigail R A Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, 78712, USA; Population Research Center, University of Texas at Austin, Austin, TX, 78712, USA.
| | | | | | - James Trussell
- Office of Population Research, Princeton University, Princeton, NJ, 08544, USA; Chalmers Centre, University of Edinburgh, Edinburgh, EH3 9ES, UK
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Gill R, Norman WV. Telemedicine and medical abortion: dispelling safety myths, with facts. Mhealth 2018; 4:3. [PMID: 29552565 PMCID: PMC5847856 DOI: 10.21037/mhealth.2018.01.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/11/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Roopan Gill
- Department of Obstetrics and Gynecology, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V. Norman
- Department of Obstetrics and Gynecology, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Family Practice, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Raymond EG, Blanchard K, Blumenthal PD, Cleland K, Foster AM, Gold M, Grossman D, Pendergast MK, Westhoff CL, Winikoff B. Sixteen Years of Overregulation: Time to Unburden Mifeprex. N Engl J Med 2017; 376:790-794. [PMID: 28225670 DOI: 10.1056/nejmsb1612526] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Paul D Blumenthal
- Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Kelly Cleland
- Office of Population Research, Princeton University, Princeton, NJ
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa
| | - Marji Gold
- Albert Einstein College of Medicine, Bronx, NY
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
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Dawson A, Bateson D, Estoesta J, Sullivan E. Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia. BMC Health Serv Res 2016; 16:612. [PMID: 27770797 PMCID: PMC5075393 DOI: 10.1186/s12913-016-1846-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to improve access comprehensive medical and early surgical abortion in high income countries. This review therefore aims to identify quality studies of abortion services to provide insight into how access to services can be improved in Australia. METHODS We undertook a structured search of six bibliographic databases and hand-searching to ascertain peer reviewed primary research in English between 2005 and 2015. Qualitative and quantitative study designs were deemed suitable for inclusion. A deductive content analysis methodology was employed to analyse selected manuscripts based upon a framework we developed to examine access to early abortion services. RESULTS This review identified the dimensions of access to surgical and medical abortion at clinic or hospital-outpatient based abortion services, as well as new service delivery approaches utilising a remote telemedicine approach. A range of factors, mostly from studies in the United Kingdom and United States of America were found to facilitate improved access to abortion, in particular, flexible service delivery approaches that provide women with cost effective options and technology based services. Standards, recommendations and targets were also identified that provided services and providers with guidance regarding the quality of abortion care. CONCLUSIONS Key insights for service delivery in Australia include the: establishment of standards, provision of choice of procedure, improved provider education and training and the expansion of telemedicine for medical abortion. However, to implement such directives leadership is required from Australian medical, nursing, midwifery and pharmacy practitioners, academic faculties and their associated professional associations. In addition, political will is needed to nationally decriminalise abortion and ensure dedicated public provision that is based on comprehensive models tailored for all populations.
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Affiliation(s)
- Angela Dawson
- Faculty of Health, University of Technology, Sydney (UTS), P.O. Box 123, Ultimo, NSW 2007, Sydney, NSW Australia
| | - Deborah Bateson
- Discipline, Gynaecology and Neonatology, University of Sydney, Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW 2131 Australia
| | - Jane Estoesta
- Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW 2131 Australia
| | - Elizabeth Sullivan
- Public Health, Faculty of Health, University of Technology, Sydney (UTS), Jones Street, Sydney, NSW Australia
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Grindlay K, Grossman D. Telemedicine provision of medical abortion in Alaska: Through the provider’s lens. J Telemed Telecare 2016; 23:680-685. [DOI: 10.1177/1357633x16659166] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Since 2011, Planned Parenthood of the Great Northwest and the Hawaiian Islands has been providing medical abortion via telemedicine at several clinics in Alaska. The purpose of this study was to evaluate providers’ experiences with telemedicine provision of medical abortion in Alaska using qualitative methods. In particular, we aimed to learn more about the impacts of telemedicine on patients, staff, and clinic operations and potential lessons for other service delivery settings. Methods Between October and November 2013, eight in-depth interviews were conducted with clinic providers and staff who were involved with the provision of medical abortion using telemedicine at Planned Parenthood of the Great Northwest and the Hawaiian Islands clinics in Alaska. All interviews were digitally recorded and transcribed verbatim, and data were analysed qualitatively with inductive coding using grounded theory methods. Results Providers reported that telemedicine provision of medical abortion facilitated a more patient-centred approach to care where women were able to be seen sooner, have greater choice in abortion procedure type, and could be seen closer to their home. Providers felt that it was easy to integrate the new technology into clinic operations, and that a telemedicine visit largely required the same overall processes and clinic flow as an in-person visit, with minor additions related to technological set-up for the doctor interface. Discussion These findings are consistent with previously published literature on medical abortion provided via telemedicine, and indicate high acceptability among providers and the appropriateness for telemedicine application to this healthcare service.
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Affiliation(s)
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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