PT  - JOURNAL ARTICLE
AU  - Kristina Killinger
AU  - Sophie Günther
AU  - Rebecca Gomperts
AU  - Hazal Atay
AU  - Margit Endler
TI  - Why women choose abortion through telemedicine outside the formal health sector in Germany: a mixed-methods study
AID  - 10.1136/bmjsrh-2020-200789
DP  - 2022 Jan 01
TA  - BMJ Sexual & Reproductive Health
PG  - e6--e12
VI  - 48
IP  - e1
4099  - http://jfprhc.bmj.com/content/48/e1/e6.short
4100  - http://jfprhc.bmj.com/content/48/e1/e6.full
SO  - BMJ Sex Reprod Health2022 Jan 01; 48
AB  - Introduction Women on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector. In April 2019 they opened their helpdesk to Germany. Our aim was to understand the motivations, and perceived barriers to access, for women who choose telemedicine abortion outside the formal health sector in Germany.Methods We conducted a parallel convergent mixed-methods study among 1090 women consulting WoW from Germany between 1 January and 31 December 2019. We performed a cross-sectional study of data contained in online consultations and a content analysis of 108 email texts. Analysis was done until saturation; results were merged and triangulation used to validate results.Results The quantitative analysis found that the need for secrecy (n=502, 48%) and the wish for privacy (n=500, 48%) were frequent reasons for choosing telemedicine abortion. Adolescents were more likely to report secrecy, cost, stigma and legal restrictions as reasons for using telemedicine abortion compared with older women. The content analysis developed two main themes and seven subsidiary categories, (1) internal motivations for seeking telemedicine abortion encompassing (i) autonomy, (ii) perception of external threat and (iii) shame and stigma, and (2) external barriers to formal abortion care encompassing (iv) financial stress, (v) logistic barriers to access, (vi) provider attitudes and (vii) vulnerability of foreigners.Conclusions Women in Germany who choose telemedicine abortion outside the formal health sector do so both from a place of empowerment and a place of disempowerment. Numerous barriers to abortion access exist in the formal sector which are of special relevance to vulnerable groups such as adolescents and undocumented immigrants.All original data are available upon reasonable request to the researchers.