Telemedicine as an alternative way to access abortion in Italy and characteristics of requests during the COVID-19 pandemic

Abstract

IntroductionInduced abortion is legal in Italy but with restrictions. The online abortion provider Women on Web (WoW) serves as an alternative way to access abortion. The COVID-19 pandemic has affected sexual and reproductive health worldwide. Italy was one of the first countries hit by the pandemic and imposed strict lockdown measures. We aimed to understand why women requested WoW abortion in Italy and how this was affected by the pandemic.MethodsWe conducted an observational study analysing requests made to WoW before and during the pandemic. We analysed 778 requests for medical abortion from Italy between 1 March 2019 to 30 November 2020 and compared the characteristics of requests submitted before and during the pandemic. We also performed subgroup analysis on teenagers and COVID-19-specific requests.ResultsThere was an increase in requests during the COVID-19 pandemic compared with the previous year (12% in the first 9 months). The most common reasons for requesting a telemedicine abortion through WoW were privacy-related (40.9%); however, this shifted to COVID-19-specific (50.3%) reasons during the pandemic. Requests from teenagers (n=61) were more frequently made at later gestational stages (p=0.003), had a higher prevalence of rape (p=0.003) as the cause of unwanted pregnancies, and exhibited less access to healthcare services compared with adult women.ConclusionsThere was an increase in total demand for self-managed abortion during the pandemic and reasons for requesting an abortion changed, shifting from privacy-related to COVID-19-specific reasons. This study also highlighted the uniquely vulnerable situation of teenagers with unwanted pregnancies seeking self-managed abortion.

A Narrative Review of the Launch and the Deployment of Telemedicine in Italy during the COVID-19 Pandemic

“…The eligibility process applied to the selected references, after the elimination of the duplicated ones, returned 39 works [ 5 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], including a review focused on the relationship between telemedicine and radiotherapy [ 39 ].…”

“…The boundaries of the use of telemedicine have been expanded during the pandemic. Three examples are show in transgender mental health monitoring [ 26 ], in the field of the abortion [ 18 , 19 ], and in the field of the animal-assisted therapy. Transgender people are a vulnerable group with a higher incidence of mental health issues and, during the COVID-19 outbreak, they may have faced psychological, physical, and social obstacles.…”

“…It highlighted how telemedicine services may serve to mitigate negative psychological effects. The studies in [ 18 , 19 ] focused on the application of telemedicine in the field of abortion. Induced abortion is legal in Italy, but with restrictions.…”

“… A subsequent broad-spectrum use in traditional applications—such as diabetology, cardiology, oncology, and neurology—but also in original sectors, such as application in bariatric centers, wound care, urological benign diseases, endocrinology, inflammatory bowel disease, and chronic liver disease ( Table 3 ). New emerging applications, such as mental health in transgender people [ 26 ], telemedicine applied to abortion [ 18 , 19 ], and the assessment of the impact of the animal-assisted therapy [ 54 ]. Studies based on surveys [ 21 , 22 , 25 , 29 , 38 , 43 , 47 ] that have shown a high acceptance of telemedicine, the determinants, and a direct or indirect interest in continuing with these solutions in the future.…”

“…New emerging applications, such as mental health in transgender people [ 26 ], telemedicine applied to abortion [ 18 , 19 ], and the assessment of the impact of the animal-assisted therapy [ 54 ].…”