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Abstract
Objectives In most European countries, patients seeking medication abortion during the COVID-19 pandemic are still required to attend healthcare settings in person. We assessed whether demand for self-managed medication abortion provided by online telemedicine increased following the emergence of COVID-19.
Methods We examined 3915 requests for self-managed abortion to online telemedicine service Women on Web (WoW) between 1 January 2019 and 1 June 2020. We used regression discontinuity to compare request rates in eight European countries before and after they implemented lockdown measures to slow COVID-19 transmission. We examined the prevalence of COVID-19 infection, the degree of government-provided economic support, the severity of lockdown travel restrictions and the medication abortion service provision model in countries with and without significant changes in requests.
Results Five countries showed significant increases in requests to WoW, ranging from 28% in Northern Ireland (97 requests vs 75.8 expected requests, p=0.001) to 139% in Portugal (34 requests vs 14.2 expected requests, p<0.001). Two countries showed no significant change in requests, and one country, Great Britain, showed an 88% decrease in requests (1 request vs 8.1 expected requests, p<0.001). Among countries with significant increases in requests, abortion services are provided mainly in person in hospitals or abortion is unavailable and international travel was prohibited during lockdown. By contrast, Great Britain implemented a fully remote no-test telemedicine service.
Conclusion These marked changes in requests for self-managed medication abortion during the COVID-19 pandemic demonstrate demand for remote models of care, which could be fulfilled by expanding access to medication abortion by telemedicine.
- abortion
- health policy
- health services accessibility
Data availability statement
No additional data are available. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
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Data availability statement
No additional data are available. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Footnotes
Contributors ARAA and CA conceived of the original research question. ARAA, CA, JGS and JS contributed to the study design. RG provided the deidentified data. JS conducted the statistical analyses and prepared the tables and figures. ARAA and CA did the initial data interpretation. ARAA wrote the first draft of the manuscript. All authors contributed to final data interpretation, revised first and subsequent drafts critically for intellectual content and approved the final manuscript. All authors agree to be accountable for all aspects of the work. ARAA is the manuscript’s guarantor.
Funding This study was supported in part by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (NIH) through Center Grant P2CHD042849, awarded to the Population Research Center at The University of Texas at Austin. The funder played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the article for publication. The authors are completely independent from the funding sources. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Disclaimer We plan to disseminate the results to people who have made requests to the Women on Web (WoW) service by having a link to the published paper included in the ‘Research’ section of the WoW website.
Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: ARAA and JS have received grant support from the Society of Family Planning and infrastructure support from the National Institutes of Health. The authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years. RG is the founder and director of Women on Web. The authors declare no other relationships or activities that could appear to have influenced the submitted work.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.