Experiences and characteristics of women seeking and completing at‐home medical termination of pregnancy through online telemedicine in Ireland and Northern Ireland: a population‐based analysis

Abstract

Irish & Northern Irish women completing at-home medical TOP report benefits for health, wellbeing and autonomy Objective To examine the characteristics and experiences of women in Ireland and Northern Ireland seeking at-home medical termination of pregnancy (TOP) using online telemedicine. Design Population-based study. Setting Ireland and Northern Ireland. Population Between January 1st 2010 and December 31st 2015, 5,650 women requested at-home medical TOP through online telemedicine initiative Women on Web (WoW). Methods We examined the demographics and circumstances of women requesting medical TOP and examined the experiences of the 1,023 women who completed TOP between January 2010 and December 2012. We conducted a content analysis of women's evaluations and used logistic regression to examine factors associated with lack of emotional support during and after TOP Main Outcome Measures Satisfaction with TOP; Feelings before and after TOP; Emotional support during TOP Results Women requesting TOP were diverse with respect to age, pregnancy circumstances, and reasons for seeking TOP. Among those completing TOP, 97% felt they made the right choice and 98% would recommend it to others in a similar situation. Women commonly reported serious mental stress caused by their pregnancies and their inability to afford travel abroad to access TOP. The feelings women most commonly reported after completing TOP were “relieved” (70%) and “satisfied (36%). Women with financial hardship had twice the risk of lacking emotional support (OR=2.0, p<0.001). Conclusions The vast majority of women who completed at-home medical TOP through WoW had a positive experience. These demonstrated benefits to health and wellbeing contribute new evidence to the debate surrounding abortion laws in Ireland and Northern Ireland.

Empowerment and Privacy? Home Use of Abortion Pills in the Republic of Ireland

“…Telemedical protocols are growing more common within national health services (Grossman et al 2011;Wiebe 2013;Jabour 2015), and peer-reviewed studies confirm the safety and acceptability of WoW's service (Gomperts et al 2008(Gomperts et al , 2011. Almost all of the women who had accessed abortion pills from WoW and were included in the above survey felt that home use of pills had Aiken, Gomperts, and Trussell 2017). WoW and WHW are strongly committed to the well-being of the women who use their services.…”

“…including posters, stickers on toilet doors, and publicity stunts-such as driving an "abortion bus" around Irish towns (Hayden 2015)-designed to publicize the groups' websites. WoW has recently published data regarding the women on the island of Ireland (including both the Republic and Northern Ireland) who access their services (Aiken, Gomperts, and Trussell 2017). Between January 1, 2010, and December 31, 2015, 5,650 women requested abortion pills, with the numbers more than doubling across that period.…”

“…Abortion pills can serve to empower women, with significant echoes of the pro-choice vision with which I opened. One woman treated by WoW wrote to thank them "for enabling women to have control over their bodies," with another explaining that the service had given her "another chance to continue my personal battle as a single mother to create a good quality of life for my child, working hard in three jobs to make ends meet and create opportunities and potential for her future" (Aiken, Gomperts, andTrussell 2017, 1212).…”

How can a state control swallowing? The home use of abortion pills in Ireland

“…52 It reveals that, from 1 January 2010 to 31 December 2015, 5,650 women from across Northern Ireland and the Republic Ireland requested abortion pills from Women on Web, one of the two providers discussed above, with the numbers of online consultations more than doubling over that period. This suggests that a sizeable proportion of the initial contacts with Women on Web noted above resulted in eventual home use of pills.…”

Unequal Family Lives

“…Where religious opposition becomes entrenched, as which occurred in the United States to systematic sex education and provision of contraception, or in the Republic of Ireland to divorce and abortion, the result tends to be the exacerbation of class and regional differences. In the case of abortion for example, the Irish elite evade the religiously based restrictions through travel abroad while the poor are subject to them (Aiken, Gomperts, and Trussell 2016). In the United States, the class-based differences in unintended pregnancies grew substantially between the early 1990s and 2009 at the same time that abortion rates fell for all groups (Carbone and Cahn 2014).…”