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Telemedicine as an alternative way to access abortion in Italy and characteristics of requests during the COVID-19 pandemic
  1. Karin Brandell1,2,
  2. Hannah Vanbenschoten1,3,
  3. Mirella Parachini4,5,
  4. Rebecca Gomperts6,
  5. Kristina Gemzell-Danielsson1,7
  1. 1 Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  2. 2 Sodertalje Hospital, Sodertalje, Sweden
  3. 3 Department of Bioengineering, University of Washington, Seattle, Washington, USA
  4. 4 AMICA (Associazione Medici Italiani Contraccezione e Aborto), Rome, Italy
  5. 5 International Federation of Abortion and Contraception Professionals, Vienna, Austria
  6. 6 Women on Web, Amsterdam, The Netherlands
  7. 7 Gynecology and Reproductive Medicine, Karolinska Universitetssjukhuset, Stockholm, Sweden
  1. Correspondence to Dr Karin Brandell, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden; karin.brandell{at}


Introduction Induced abortion is legal in Italy but with restrictions. The online abortion provider Women on Web (WoW) serves as an alternative way to access abortion. The COVID-19 pandemic has affected sexual and reproductive health worldwide. Italy was one of the first countries hit by the pandemic and imposed strict lockdown measures. We aimed to understand why women requested WoW abortion in Italy and how this was affected by the pandemic.

Methods We conducted an observational study analysing requests made to WoW before and during the pandemic. We analysed 778 requests for medical abortion from Italy between 1 March 2019 to 30 November 2020 and compared the characteristics of requests submitted before and during the pandemic. We also performed subgroup analysis on teenagers and COVID-19-specific requests.

Results There was an increase in requests during the COVID-19 pandemic compared with the previous year (12% in the first 9 months). The most common reasons for requesting a telemedicine abortion through WoW were privacy-related (40.9%); however, this shifted to COVID-19-specific (50.3%) reasons during the pandemic. Requests from teenagers (n=61) were more frequently made at later gestational stages (p=0.003), had a higher prevalence of rape (p=0.003) as the cause of unwanted pregnancies, and exhibited less access to healthcare services compared with adult women.

Conclusions There was an increase in total demand for self-managed abortion during the pandemic and reasons for requesting an abortion changed, shifting from privacy-related to COVID-19-specific reasons. This study also highlighted the uniquely vulnerable situation of teenagers with unwanted pregnancies seeking self-managed abortion.

  • abortion
  • induced
  • adolescent
  • COVID-19

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  • RG and KG-D contributed equally.

  • Contributors KB, KG-D and RG designed the study. RG supplied the data. HV performed the statistical analysis. MP interpreted the data in the Italian setting and had input on the manuscript writing. KB and HV wrote the initial manuscript draft. KG-D was the guarantor of the study.

  • Funding This study was funded by the Swedish Research Council (2017-00932), Karolinska Institutet, Region Stockholm (combined residency and PhD training programme).

  • Competing interests HV has received grants/contracts from Fulbright Sweden and University of Washington. MP has received support for attending meetings/travelling from ExcelGyn and is on the International Advisory Board for ExcelGyn. KG-D has received consulting fess from Bayer, MSD, Gedeon Richter, Mithra, Exeltis, MedinCell, Cirqle, Natural Cycles, Exelgyn, Campus Pharma and HRA-Pharma. KG-D has received payments or honoraria for lectures etc. from Bayer, MSD, Gedeon Richter, Mithra, Exeltis, Exelgyn and Campus Pharma. KG-D participates in advisory boards/data and safety monitoring boards (DSMB) for Gedeon Richter and Bayer. KG-D has unpaid board memberships and similar for the International Federation of Gynecology and Obstetrics (FIGO), the World Health Organization (WHO) Department of Sexual and Reproductive Health and Research (SRH) and Human Reproduction Programme (HRP), the European Society of Contraception and Reproductive Health (ESC), the International Federation for Professionals in Abortion and Contraception (FIAPAC) and the Faculty of Sexual & Reproductive Healthcare (FSRH)/Royal College of Obstetricians & Gynaecologists in the UK. RG is the founder of Women on Web (WoW).

  • 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.