Telehealth for Addressing Sexual and Reproductive Health and Rights Needs During the COVID-19 Pandemic and Beyond: A Hybrid Telemedicine-Community Accompaniment Model for Abortion and Contraception Services in Pakistan

Abstract

The COVID-19 pandemic led overburdened health care systems to deprioritize essential sexual and reproductive healthcare, including abortion and contraception care, while accelerating shifts in healthcare delivery to digital technologies. However, in many countries, including Pakistan, inequalities in access to digital technologies remain, presenting an opportunity for interventions that both increase access to deprioritized sexual and reproductive health and rights (SRHR) services and overcome the digital divide in delivering digital solutions to those in need of SRHR services. In June 2020, Ipas Pakistan partnered with Sehat Kahani (SK), a local health care NGO and telehealth service, and an existing network of Lady Health Workers (LHWs) to launch a novel hybrid telemedicine-community accompaniment pilot. The model linked women via LHWs with mobile devices to online providers for telemedicine consultations for SRH, including abortion services, contraception, and other gynecological consultations. In June 2020, we trained 98 LHWs and 22 telehealth doctors. Between June 2020 and March 2021, a total of 176 women were referred by LHWs for telehealth consultations. Among women who received abortion services, nearly all (90%) reported complete uterine evacuation. No serious adverse events were reported. Overall satisfaction was high; 81% reported being satisfied, and 86% said it is likely they would recommend the telehealth service to others. Data show that the provision of SRHR services via a telehealth-accompaniment model can be successfully implemented in Pakistan. Outcome data show high satisfaction and good clinical outcomes for women accessing care through this model. However, more data are needed to understand the full potential of this model. Barriers to digital health models, such as poor or inconsistent internet access, remain in places like Pakistan, especially in rural settings. This approach has its limitations but should be considered as an option in settings with similarly established community health networks and inequitable access to digital health.

Reach, experience, and acceptability of an abortion self-care intervention in Bolivia: a mixed-methods evaluation

“…Similar models that employ non-clinical support for medical abortion exist throughout the world in a diverse range of legal settings, including Pakistan, Argentina, Mexico, Peru, Ireland, Tanzania, Nigeria, and Indonesia. 13 , 15–19 , 28 , 32–35 The value of ASC has become even more pronounced where legal restrictions on abortion proliferate, and as the COVID-19 pandemic led under-staffed, under-resourced health facilities to deprioritise in-clinic abortion services. While full decriminalisation of abortion is essential to ensure access to abortion, as emphasised in the recent WHO abortion guidelines, 14 decriminalisation may take some time to achieve.…”

Women’s Access to Sexual and Reproductive Health Services during Confinement Due to the COVID-19 Pandemic in Spain

“…However, the results arising from this research indicate that some women were not able to have their demand met, as was the case in many countries [ 21 ]. However, the digital gap which might be experienced by the most vulnerable collective groups that were not educated on new technologies or lacked good quality access to the Internet should indeed be considered [ 26 ].…”

Telemedicine Abortion

“…These findings are comparable to the safety of medication abortion provided in clinic, both from prior studies and in a randomized controlled trial comparing telemedicine to in-person medication abortion. 45,49 In a majority of studies evaluating telemedicine for medication abortion, preabortion tests, including ultrasound, hCG, or pelvic examination, were compulsory, 6,9,[13][14][15][43][44][45][46][47]50,51 while in a few, ultrasound and/or laboratory tests were only required in cases of uncertain gestation or to confirm intrauterine pregnancies among patients who had already undergone clinical assessment. 4,24,36,42,48,52 Aiken et al 24 and Kerestes et al 13 showed comparable efficacy for no-test telemedicine abortion and medication abortion with mandatory preabortion laboratory testing, imaging studies, or physical examination, whereas Anger et al 52 found higher rates of incomplete abortion in the no-test group versus testing group (risk difference 4.0%).…”