Demand for Self-Managed Medication Abortion Through an Online Telemedicine Service in the United States

Abstract

Objectives. To examine demand for abortion medications through an online telemedicine service in the United States. Methods. We examined requests from US residents to the online telemedicine abortion service Women on Web (WoW) between October 15, 2017, and August 15, 2018. We calculated the population-adjusted rate of requests by state and examined the demographics, clinical characteristics, and motivations of those seeking services, comparing those in states with hostile versus supportive abortion policy climates. Results. Over 10 months, WoW received 6022 requests from US residents; 76% from hostile states. Mississippi had the highest rate of requests (24.9 per 100 000 women of reproductive age). In both hostile and supportive states, a majority (60%) reported a combination of barriers to clinic access and preferences for self-management. Cost was the most common barrier (71% in hostile states; 63% in supportive states; P < .001). Privacy was the most common preference (49% in both hostile and supportive states; P = .66). Conclusions. Demand for self-managed medication abortion through online telemedicine is prevalent in the United States. There is a public health justification to make these abortions as safe, effective, and supported as possible.

COVID‐19 and Independent Abortion Providers: Findings from a Rapid‐Response Survey

“…Respondents in these regions were more likely than those in other areas to report having had to temporarily close their clinics and to have canceled or postponed abortion services. This pattern of findings is consistent with results from a recent study that documented an increase in requests for medication abortion pills to an online service that supports people self‐managing abortions 23 . In addition, it appears that some preexisting restrictive abortion policies—such as requiring in‐person visits and banning telemedicine for abortion—have gotten in the way of abortion clinics being able to provide services in a manner that reduces COVID‐19 risks 24…”

“…This pattern of fi ndings is consistent with results from a recent study that documented an increase in requests for medication abortion pills to an online service that supports people self-managing abortions. 23 In addition, it appears that some preexisting restrictive abortion policies-such as requiring in-person visits and banning telemedicine for abortion-have gotten in the way of abortion clinics being able to provide services in a manner that reduces COVID-19 risks. 24 Our fi ndings suggest that abortion clinics have experienced short-term fi nancial needs as well as challenges in retaining and supporting their workforce.…”

Texas women’s decisions and experiences regarding self-managed abortion

“…We suspect that self-managed abortion may become more common if clinic-based abortion care becomes more difficult to access, especially among women in south Texas where misoprostol may be more accessible due to the proximity to Mexico, and among poor women -who make up more than half of all abortion patients [1] and face barriers to accessing reproductive health care. Indeed, a recent study of requests to an online service that provides medication abortion to people living in countries where abortion is legally restricted, and does not provide services to the US, found that three-quarters of the more than 6000 requests from US residents received in a 10-month period in 2017-2018 were from residents of states hostile to abortion [19]. Reproductive health providers can play a key role in supporting the health and well-being of women interested in self-managing abortion for whom clinic-based care is difficult to obtain.…”

Prevalence of Self-Managed Abortion Among Women of Reproductive Age in the United States

“… 1 People’s reasons for SMA are varied, and include both difficulty accessing facility-based abortion care and a preference for a more private or natural abortion experience. 2 , 3 , 4 …”