“It was close enough, but it wasn't close enough”: A qualitative exploration of the impact of direct-to-patient telemedicine abortion on access to abortion care

Kerestes, Courtney; Delafield, Rebecca; Elia, Jennifer; Chong, Erica; Kaneshiro, Bliss; Soon, Reni

doi:10.1016/j.contraception.2021.04.028

Cited by 33 publications

(36 citation statements)

References 18 publications

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“…Some participants worried that telemedicine might alert others in their household or community to their SRH needs. However, research has also highlighted the potential for telemedicine to promote privacy and anonymity in certain contexts such as abortion care 24. Given their varying needs and preferences, our data provide evidence that SRH patients should have the option of in-person, over-the-phone or video appointments to meet varying needs and preferences.…”

Section: Discussionmentioning

confidence: 81%

“…This study provides detailed qualitative evidence of the mixed picture concerning its acceptability and suitability. Corroborating wider research on adults’ experiences of SRH telemedicine,3 5 24 25 some Natsal-COVID participants held positive attitudes about its continuation, especially when complementing in-person care. This differs from findings among young people who hesitate to access remote SRH care 13 26 27.…”

Section: Discussionmentioning

confidence: 85%

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Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences

Pérez

Reid

Maxwell

et al. 2022

BMJ Sex Reprod Health

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IntroductionAccess to quality sexual and reproductive health (SRH) services remains imperative even during a pandemic. Our objective was to understand experiences of delayed or unsuccessful access to SRH services in Britain during the early stages of the COVID-19 pandemic.MethodsIn October and November 2020 we conducted semi-structured telephone interviews with 14 women and six men reporting an unmet need for SRH services in the Natsal-COVID survey, a large-scale quasi-representative web-panel survey of sexual health and behaviour during COVID-19 (n=6654). We purposively sampled eligible participants using sociodemographic quotas. Inductive thematic analysis was used to explore service access and quality and to identify lessons for future SRH service delivery.ResultsTwenty participants discussed experiences spanning 10 SRH services including contraception and antenatal/maternity care. Participants reported hesitancy and self-censorship of need. Accessing telemedicine and ‘socially-distanced’ services required tenacity. Challenges included navigating changing information and procedures; perceptions of gatekeepers as obstructing access; and inflexible appointment systems. Concerns about reconfigured services included reduced privacy; decreased quality of interactions with professionals; reduced informal support; and fewer preventive SRH practices. However, some participants also described more streamlined services and staff efforts to compensate for disruptions. Many viewed positively the ongoing blending of telemedicine with in-person care.ConclusionThe COVID-19 pandemic impacted access and quality of SRH services. Participants’ accounts revealed self-censorship of need, difficulty navigating shifting service configurations and perceived quality reductions. Telemedicine offers potential if intelligently combined with in-person care. We offer initial evidence-based recommendations for promoting an equitable restoration and future adaption of services.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 85%

Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences

Pérez

Reid

Maxwell

et al. 2022

BMJ Sex Reprod Health

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“…Endler and colleagues’ systematic review was conducted prior to the COVID-19 pandemic. As such, there is now a significant body of more recent research to corroborate their findings [ 3 , 14 , 39 , 41 ]. Of particular relevance to our discussion is a study conducted across the three main abortion providers in England to examine the safety, effectiveness, and acceptability of their TEMA care pathways [ 3 ].…”

Section: Tema and Safeguarding Concernsmentioning

confidence: 95%

The Case for Telemedical Early Medical Abortion in England: Dispelling Adult Safeguarding Concerns

Parsons

Romanis

2021

Health Care Anal

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Access to abortion care has been hugely affected by the COVID-19 pandemic. This has prompted several governments to permit the use of telemedicine for fully remote care pathways, thereby ensuring pregnant people are still able to access services. One such government is that of England, where these new care pathways have been publicly scrutinised. Those opposed to telemedical early medical abortion care have raised myriad concerns, though they largely centre on matters of patient safeguarding. It is argued that healthcare professionals cannot adequately carry out their safeguarding duties if the patient is not in the room with them. These concerns lack empirical support. Emerging evidence suggests that safeguarding processes may, in fact, be more effective within telemedical abortion care pathways. In this article, we address two specific safeguarding concerns: (1) that a remote consultation prevents a healthcare professional from identifying instances of abuse, and (2) that healthcare professionals cannot reliably confirm the absence of coercion during a remote consultation. We demonstrate that such concerns are misplaced, and that safeguarding may actually be improved in telemedical care pathways as victims of abuse may find it easier to engage with services. It is inevitable that some individuals will fall through the net, but this is unavoidable even with in-person care and thus does not constitute a strong critique of the use of telemedicine in abortion care. These safeguarding concerns set aside, then, we argue that the current approval that enables telemedical early medical abortion should be afforded permanence.

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“…If Roe is overturned, medication abortions will also be banned in Arkansas. New research from the Gynunity Project has demonstrated the clinical effectiveness and safety of medication abortion delivered without a face-to-face interaction with a clinician (Raymond et al 2020;Kerestes et al 2021;Schmidt-Hansen et al 2020;Upadhyay and Grossman 2019). In response, the Food and Drug Administration recently ruled that abortion pills could be delivered through the mail instead of having patients obtain them in person by a certified health care provider (Belluck 2021).…”

Section: Roementioning

confidence: 99%

Another day, another visit: Impact of Arkansas’ mandatory waiting period for women seeking an abortion by demographic groups

Altındağ

Joyce²

2022

Journal of Public Economics

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“It was close enough, but it wasn't close enough”: A qualitative exploration of the impact of direct-to-patient telemedicine abortion on access to abortion care

Cited by 33 publications

References 18 publications

Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences

Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences

The Case for Telemedical Early Medical Abortion in England: Dispelling Adult Safeguarding Concerns

Another day, another visit: Impact of Arkansas’ mandatory waiting period for women seeking an abortion by demographic groups

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