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. 2021 Oct;47(4):238-245.
doi: 10.1136/bmjsrh-2020-200880. Epub 2021 Jan 11.

Demand for self-managed online telemedicine abortion in eight European countries during the COVID-19 pandemic: a regression discontinuity analysis

Abigail R A Aiken  1 , Jennifer E Starling  2 , Rebecca Gomperts  3 , James G Scott  4 , Catherine E Aiken  5
Affiliations

Demand for self-managed online telemedicine abortion in eight European countries during the COVID-19 pandemic: a regression discontinuity analysis

Abigail R A Aiken et al. BMJ Sex Reprod Health. 2021 Oct.

Abstract

Objectives: In most European countries, patients seeking medication abortion during the COVID-19 pandemic are still required to attend healthcare settings in person. We assessed whether demand for self-managed medication abortion provided by online telemedicine increased following the emergence of COVID-19.

Methods: We examined 3915 requests for self-managed abortion to online telemedicine service Women on Web (WoW) between 1 January 2019 and 1 June 2020. We used regression discontinuity to compare request rates in eight European countries before and after they implemented lockdown measures to slow COVID-19 transmission. We examined the prevalence of COVID-19 infection, the degree of government-provided economic support, the severity of lockdown travel restrictions and the medication abortion service provision model in countries with and without significant changes in requests.

Results: Five countries showed significant increases in requests to WoW, ranging from 28% in Northern Ireland (97 requests vs 75.8 expected requests, p=0.001) to 139% in Portugal (34 requests vs 14.2 expected requests, p<0.001). Two countries showed no significant change in requests, and one country, Great Britain, showed an 88% decrease in requests (1 request vs 8.1 expected requests, p<0.001). Among countries with significant increases in requests, abortion services are provided mainly in person in hospitals or abortion is unavailable and international travel was prohibited during lockdown. By contrast, Great Britain implemented a fully remote no-test telemedicine service.

Conclusion: These marked changes in requests for self-managed medication abortion during the COVID-19 pandemic demonstrate demand for remote models of care, which could be fulfilled by expanding access to medication abortion by telemedicine.

Keywords: abortion; health policy; health services accessibility.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: ARAA and JS have received grant support from the Society of Family Planning and infrastructure support from the National Institutes of Health. The authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years. RG is the founder and director of Women on Web. The authors declare no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Observed versus expected requests to Women on Web for all countries included in the analysis. Cumulative requests in the ‘before’ versus ‘after’ periods are in black and orange, respectively. Vertical dashed lines show the dates when stay-at-home orders were announced. The blue line shows the model without any discontinuities (the null model), and the green line shows the model fit with a discontinuity. for the stay-at-home order. The pink lines are the 250 Monte Carlo simulations from the null model, which support the likelihood ratio test’s finding that the model with discontinuities is a significantly better fit than the null model.
See this image and copyright information in PMC

References

    1. Council on Foreign Relations Women Around the World & Women and Foreign Policy Program. Abortion in the Time of COVID-19, 2020. Available: https://www.cfr.org/blog/abortion-time-covid-19 [Accessed 4 Sep 2020].
    1. European Parliamentary Forum for Sexual and Reproductive Rights & International Planned Parenthood Federation Report Women and girls left without care: a snapshot in time during COVID-19, 2020. Available: https://www.epfweb.org/sites/default/files/2020-05/epf_-_ipff_en_joint_r... [Accessed 4 Sep 2020].
    1. Department of Health and Social Care Temporary approval of home use for both stages of early medical abortion in England, 2020. Available: https://www.gov.uk/government/publications/temporary-approval-of-home-us... [Accessed 4 Sep 2020].
    1. Department of Health and Social Services Temporary approval of home use for both stages of early medical abortion in Wales, 2020. Available: https://gov.wales/temporary-approval-home-use-both-stages-early-medical-... [Accessed 4 Sep 2002].
    1. Scottish Government Chief Medical Officer Directorate Temporary approval of home use for both stages of early medical abortion in Scotland, 2020. Available: https://www.sehd.scot.nhs.uk/cmo/CMO(2020)09.pdf [Accessed 4 Sep 2020].

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