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A qualitative study of abortion care providers’ perspectives on telemedicine medical abortion provision in the context of COVID-19
  1. John Joseph Reynolds-Wright1,2,
  2. Nicola Boydell3,
  3. Sharon Cameron1,2,
  4. Jeni Harden3
  1. 1 MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
  2. 2 Chalmers Centre, NHS Lothian, Edinburgh, UK
  3. 3 Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr John Joseph Reynolds-Wright, Chalmers Centre, NHS Lothian, Edinburgh, UK; jjrw{at}


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.

  • abortion
  • therapeutic
  • professional-patient relations
  • physician-patient relations
  • mifepristone
  • health services research
  • COVID-19

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No data are available.

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  • Twitter @doctorjjrw, @jeniharden

  • Contributors The original idea and overall study design were conceived by JH, NB, SC and JJRW. Qualitative study design, data collection and analysis were conducted by JH, NB and JJRW. JJRW prepared the initial manuscript with contributions from, and edits by, JH, NB and SC. All authors jointly approved the version to be published and are accountable for the accuracy and integrity of the work.

  • Funding The study was funded by the NHS Lothian Sexual Health and Blood Borne Virus Programme Fund (Ref. R46498 - R46499). The study was conducted by staff at the MRC Centre for Reproductive Health (JJRW and SC), which is funded by grant MR/N022556/1. NB is supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies Institute. The study funders were not involved in the research conduct or manuscript preparation.

  • Competing interests None declared.

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.