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Why women choose self-managed telemedicine abortion in the Netherlands during the COVID-19 pandemic: a national mixed methods study
  1. Nanke Cui1,2,
  2. Kristina Gemzell-Danielsson3,
  3. Rebecca Gomperts2
  1. 1 Amsterdam Public Health, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, The Netherlands
  2. 2 Women on Web International Foundation, Amsterdam, The Netherlands
  3. 3 Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
  1. Correspondence to Dr Nanke Cui, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, The Netherlands; n.a.cui{at}


Background The COVID-19 pandemic has imposed strict lockdown restrictions that have introduced barriers to in-person abortion clinic visits in the Netherlands. Women on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector.

Aim To understand the motivations and perceived barriers women faced when choosing telemedicine abortion outside the formal health sector, and how this was affected by the pandemic.

Methods 178 women who completed an online consultation on the Dutch WoW website during the period 6 March 2020 to 5 March 2021 were included in this cross-sectional cohort study and exploratory qualitative study. Patient characteristics and motivations were analysed and associated with the severity of COVID-19 restrictions. Email exchanges in which women could further describe their requests were also examined for recurrent clarification of motivations.

Results Women experienced barriers to regular abortion care due to COVID-19 restrictions and had the preference to (1) self-manage their abortion, (2) stay in the comfort of their own home, and (3) keep their abortion private. In particular, women who did not live in the cities where abortion clinics were located experienced barriers to abortion services. As COVID-19 restrictions tightened, it was more frequently mentioned that women sought help from WoW because COVID-19 restrictions and abortion care were not accessible to them in the Netherlands. In the qualitative analysis of email exchanges, the reasons of COVID-19, privacy concerns, and domestic violence were particularly evident.

Conclusions In the Netherlands, barriers to receiving adequate abortion care were exacerbated for women in vulnerable positions such as being geographically farther away from an abortion clinic, being in a deprived socioeconomic position, or being in an unsafe home situation. Similar to other medical care, abortion care should be deliverable online.

  • COVID-19
  • abortion, induced
  • Patient Reported Outcome Measures
  • Patient Rights
  • Patient Safety
  • Reproductive Health Services

Data availability statement

Data are available upon reasonable request.

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  • Contributors NC and RG conceived the original research question and contributed to the study design. RG provided the anonymised data. NC conducted the quantitative analysis and NC and RG did the qualitative analysis. RG and KGD supervised the study analysis. NC wrote the first draft of the manuscript. All authors contributed to the final data interpretation, revised the first and subsequent drafts critically, and approved the final version of the manuscript. NC is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests One of the authors (RG) was employed by the non-governmental organisation Women on Web that provides the data from this manuscript. The first author (NC) was a student intern at the same organisation.

  • 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.