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Early telemedical abortion, safeguarding, and under 18s: a qualitative study with care providers in England and Wales
  1. Elizabeth Chloe Romanis1,2,
  2. Jordan A Parsons3
  1. 1Durham Law School, Durham University, Durham, UK
  2. 2Edmond and Lily Safra Center for Ethics and Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Harvard University, Cambrdge, Massachusetts, USA
  3. 3Keele Law School, Keele University, Keele, Staffordshire, UK
  1. Correspondence to Dr Elizabeth Chloe Romanis, Durham Law School, Durham University, Durham DH1 3LE, UK; elizabeth.c.romanis{at}


Background Telemedical early medical abortion (TEMA) was introduced in England and Wales as a temporary measure in 2020 and was made permanent in 2022. While there are considerable data showing the safety, efficacy, and acceptability of TEMA for patients, there have been objections raised to TEMA based on safeguarding—particularly for people under 18 years of age. Little is known about abortion care providers’ views and experiences of carrying out their safeguarding duties with people aged under 18 in the shift to TEMA.

Methods This is a qualitative study involving online semi-structured interviews and reflexive thematic analysis. Audio-recorded, semi-structured interviews with abortion providers in England and Wales (n=20) generated data about their views and experiences of safeguarding in telemedical abortion care. Recordings were transcribed verbatim and then subject to reflexive thematic analysis to construct themes.

Results While the study was designed with adult safeguarding in mind, the safeguarding of under 18s became a key area of discussion. Three major themes were constructed in relation to under 18s: (1) age as a risk factor in safeguarding; (2) telemedicine as improving access to care; and (3) telemedicine as enhancing communication.

Conclusion Care providers believe TEMA has benefitted the under 18s. There was a strong feeling both that TEMA had improved access (which, in turn, improved safeguarding) and that under 18s were comfortable communicating using remote means. Providers believe safeguarding proformas must account for the different nature of risks where service users are under 18, but that it is disproportionate to assume that TEMA is unsuitable for all under 18s or groups of under 18s.

  • abortion
  • Patient Safety
  • qualitative research
  • adolescent
  • Physician-Patient Relations

Data availability statement

No data are available. Not applicable.

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  • Twitter @ECRomanis, @Jordan_Parsons_

  • Contributors JAP and ECR designed the content of the research. JAP led recruitment. ECR conducted eight interviews and JAP conducted 12 interviews. Both authors carried out the primary analysis. ECR led the analysis and writing on this paper. ECR is the guarantor of this work.

  • Funding Funding to support this study was awarded by the Institute of Medical Ethics (Research in Medical Ethics Funding Scheme).

  • 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.