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1.
Artigo em Inglês | MEDLINE | ID: mdl-33431614

RESUMO

OBJECTIVES: In most European countries, patients seeking medication abortion during the COVID-19 pandemic are still required to attend healthcare settings in person. We assessed whether demand for self-managed medication abortion provided by online telemedicine increased following the emergence of COVID-19. METHODS: We examined 3915 requests for self-managed abortion to online telemedicine service Women on Web (WoW) between 1 January 2019 and 1 June 2020. We used regression discontinuity to compare request rates in eight European countries before and after they implemented lockdown measures to slow COVID-19 transmission. We examined the prevalence of COVID-19 infection, the degree of government-provided economic support, the severity of lockdown travel restrictions and the medication abortion service provision model in countries with and without significant changes in requests. RESULTS: Five countries showed significant increases in requests to WoW, ranging from 28% in Northern Ireland (97 requests vs 75.8 expected requests, p=0.001) to 139% in Portugal (34 requests vs 14.2 expected requests, p<0.001). Two countries showed no significant change in requests, and one country, Great Britain, showed an 88% decrease in requests (1 request vs 8.1 expected requests, p<0.001). Among countries with significant increases in requests, abortion services are provided mainly in person in hospitals or abortion is unavailable and international travel was prohibited during lockdown. By contrast, Great Britain implemented a fully remote no-test telemedicine service. CONCLUSION: These marked changes in requests for self-managed medication abortion during the COVID-19 pandemic demonstrate demand for remote models of care, which could be fulfilled by expanding access to medication abortion by telemedicine.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33361119

RESUMO

BACKGROUND: After having one of the most restrictive abortion laws worldwide, Ireland legalised abortion in January 2019. We examine how legalisation impacted on demand for online telemedicine outside the jurisdiction. METHODS: We analysed anonymised data from 534 people from Ireland seeking online telemedicine abortion prior to legalisation (January-March and October-December 2018) and in the first 3 months following legalisation (January-March 2019). Numbers, characteristics and reasons for seeking the service before and after legalisation were compared. Content analysis of emails from people seeking the service following legalisation explored reasons for seeking care. RESULTS: Half as many people contacted Women on Web in the 3 months immediately after legalisation as compared with contacts 12 months prior (103 vs 221). Of these, the proportion receiving the service reduced, from 72% prior to legalisation to 26% after legalisation (p≤0.001). After legalisation, access related reasons for seeking online telemedicine featured less while reasons relating to privacy, stigma and avoiding protestors featured more. CONCLUSIONS: People continued to seek abortion through online telemedicine after legalisation, though the number of contacts reduced by half and the proportion receiving the service decreased considerably. To address access issues, policy measures should promote normalisation of abortion, legislate for safe zones around providers, and consider access in situations of coercive control or abuse including the role of telemedicine in the local model of care. Abortion provided through online telemedicine continues to be an important part of providing safe, accessible abortion even after legalisation.

4.
Artigo em Inglês | MEDLINE | ID: mdl-33229399

RESUMO

INTRODUCTION: Women on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector. In April 2019 they opened their helpdesk to Germany. Our aim was to understand the motivations, and perceived barriers to access, for women who choose telemedicine abortion outside the formal health sector in Germany. METHODS: We conducted a parallel convergent mixed-methods study among 1090 women consulting WoW from Germany between 1 January and 31 December 2019. We performed a cross-sectional study of data contained in online consultations and a content analysis of 108 email texts. Analysis was done until saturation; results were merged and triangulation used to validate results. RESULTS: The quantitative analysis found that the need for secrecy (n=502, 48%) and the wish for privacy (n=500, 48%) were frequent reasons for choosing telemedicine abortion. Adolescents were more likely to report secrecy, cost, stigma and legal restrictions as reasons for using telemedicine abortion compared with older women. The content analysis developed two main themes and seven subsidiary categories, (1) internal motivations for seeking telemedicine abortion encompassing (i) autonomy, (ii) perception of external threat and (iii) shame and stigma, and (2) external barriers to formal abortion care encompassing (iv) financial stress, (v) logistic barriers to access, (vi) provider attitudes and (vii) vulnerability of foreigners. CONCLUSIONS: Women in Germany who choose telemedicine abortion outside the formal health sector do so both from a place of empowerment and a place of disempowerment. Numerous barriers to abortion access exist in the formal sector which are of special relevance to vulnerable groups such as adolescents and undocumented immigrants.

6.
Womens Health Issues ; 30(3): 161-166, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859189

RESUMO

INTRODUCTION: U.S. servicewomen have high rates of unintended pregnancy, but federal policy prohibits abortion provision at military treatment facilities and military insurance coverage of abortion, except in cases of rape, incest, or a life-endangering pregnancy. Such restrictions pose challenges to abortion access for servicemembers, particularly during deployment. We aimed to explore the experiences of U.S. servicewomen when accessing abortion during overseas tours and deployment. METHODS: We reviewed de-identified data from email inquiries and online consultation forms from U.S. servicewomen or military spouses seeking medication abortion from the telemedicine service Women on Web between January 2010 and December 2017. We used descriptive statistics and inductively coded textual responses to describe client characteristics, circumstances of pregnancy, reasons for abortion, and barriers to abortion care. RESULTS: Our sample included data for 323 individuals. Reasons for abortion related to military service included disruption of deployment, fear of military reprimand, and potential career impacts. Additionally, servicemembers faced barriers to abortion access related to overseas military deployment or tour, including a lack of legal abortion in-country, limited financial resources, language barriers, travel restrictions, and a lack of confidentiality. CONCLUSIONS: U.S. military servicewomen stationed in countries where safe, legal abortion is restricted or unavailable face deployment-related barriers to abortion care, which compound those barriers they may face regardless of deployment status. Removal of federal bans on the provision and coverage of abortion care and improved education about existing regulations could improve access to timely abortion care and in some cases allow servicewomen who wish to obtain abortion care to remain deployed.


Assuntos
Aspirantes a Aborto/estatística & dados numéricos , Aborto Induzido/legislação & jurisprudência , Aborto Legal/estatística & dados numéricos , Militares/estatística & dados numéricos , Adolescente , Adulto , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Internet , Gravidez , Gravidez não Planejada , Estados Unidos , Adulto Jovem
7.
Am J Public Health ; 110(1): 90-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31622157

RESUMO

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.


Assuntos
Abortivos/administração & dosagem , Aborto Induzido/métodos , Aborto Induzido/estatística & dados numéricos , Autogestão/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Aborto Induzido/economia , Aborto Induzido/psicologia , Adulto , Confidencialidade , Feminino , Idade Gestacional , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Internet/estatística & dados numéricos , Pessoa de Meia-Idade , Motivação , Gravidez , Privacidade , Autogestão/psicologia , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
9.
Contraception ; 97(2): 177-183, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28941978

RESUMO

OBJECTIVE: To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available. STUDY DESIGN: We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help. RESULTS: Over a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control. CONCLUSION: Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks. IMPLICATIONS: The presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in controlling circumstances are particularly important goals.


Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Induzido/psicologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Autoadministração/psicologia , Aborto Induzido/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Reino Unido , Adulto Jovem
10.
Eur J Contracept Reprod Health Care ; 22(5): 360-362, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29164948

RESUMO

OBJECTIVE: The aim of the study was to analyse the characteristics and experiences of women living in Hungary who accessed a medical abortion through the telemedical service Women on Web. METHODS: We examined the characteristics and experiences of 136 women who requested a medical abortion from Women on Web between June 2013 and February 2017. The main outcome measures were acceptability and satisfaction with the service. RESULTS: Of the 136 women who completed an online consultation, 118 requested a medical abortion package. Follow-up information was provided by 73 women (61.9%), of whom 49 completed the follow-up survey and 24 provided follow-up information via email. Of the 59 women who went ahead with a medical abortion, five (8.5%) had a surgical intervention afterwards. All women who completed the follow-up survey reported that they found a home medical abortion to be acceptable. CONCLUSION: The lack of availability of medical abortion in the public health sector in Hungary and compulsory biased counselling make medical abortion at home through telemedicine a good alternative for Hungarian women.


Assuntos
Aborto Induzido/métodos , Satisfação do Paciente/estatística & dados numéricos , Autoadministração/psicologia , Telemedicina , Aborto Induzido/psicologia , Adolescente , Adulto , Feminino , Seguimentos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Hungria , Pessoa de Meia-Idade , Autoadministração/métodos , Adulto Jovem
11.
BMJ ; 357: j2011, 2017 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-28512085

RESUMO

Objectives To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine.Design Population based study.Setting Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances.Population 1000 women who underwent self sourced medical abortion through Women on Web (WoW), an online telemedicine service, between 1 January 2010 and 31 December 2012.Main outcome measures Successful medical abortion: the proportion of women who reported ending their pregnancy without surgical intervention. Rates of adverse events: the proportion who reported treatment for adverse events, including receipt of antibiotics and blood transfusion, and deaths reported by family members, friends, or the authorities. Care seeking for symptoms of potential complications: the frequency with which women reported experiencing symptoms of a potentially serious complication and the proportion who reported seeking medical attention as advised.Results In 2010-12, abortion medications (mifepristone and misoprostol) were sent to 1636 women and follow-up information was obtained for 1158 (71%). Among these, 1023 women confirmed use of the medications, and follow-up information was available for 1000. At the time women requested help from WoW, 781 (78%) were <7 weeks pregnant and 219 (22%) were 7-9 weeks pregnant. Overall, 94.7% (95% confidence interval 93.1% to 96.0%) reported successfully ending their pregnancy without surgical intervention. Seven women (0.7%, 0.3% to 1.5%) reported receiving a blood transfusion, and 26 (2.6%, 1.7% to 3.8%) reported receiving antibiotics (route of administration (IV or oral) could not be determined). No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety three women (9.3%, 7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek medical advice, and, of these, 87 (95%, 87.8% to 98.2%) sought attention. None of the five women who did not seek medical attention reported experiencing an adverse outcome.Conclusions Self sourced medical abortion using online telemedicine can be highly effective, and outcomes compare favourably with in clinic protocols. Reported rates of adverse events are low. Women are able to self identify the symptoms of potentially serious complications, and most report seeking medical attention when advised. Results have important implications for women worldwide living in areas where access to abortion is restricted.


Assuntos
Aborto Induzido/efeitos adversos , Aborto Induzido/métodos , Internet , Autorrelato , Telemedicina , Abortivos não Esteroides/efeitos adversos , Abortivos não Esteroides/uso terapêutico , Abortivos Esteroides/efeitos adversos , Abortivos Esteroides/uso terapêutico , Adulto , Feminino , Seguimentos , Idade Gestacional , Humanos , Irlanda , Pessoa de Meia-Idade , Mifepristona/efeitos adversos , Mifepristona/uso terapêutico , Misoprostol/efeitos adversos , Misoprostol/uso terapêutico , Irlanda do Norte , Gravidez , Resultado do Tratamento , Adulto Jovem
13.
Contraception ; 89(2): 129-33, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24314910

RESUMO

OBJECTIVE: To evaluate the need for and outcome of self-administered medical abortion with mifepristone and misoprostol in Brazil, provided through Women on Web, a global telemedicine abortion service. STUDY DESIGN: A retrospective case review of women from Brazil who contacted Women on Web in 2011. Information from the online consultation, follow-up questionnaire and emails were used to analyze data including demographics, gestational age, outcome of the medical abortion and symptoms that lead to surgical interventions. RESULTS: The Women on Web website had 109779 unique visitors from Brazil, 2104 women contacted the helpdesk by email. Of the 1401 women who completed the online consultation, 602 women continued their request for a medical abortion. Of the 370 women who used the medicines, 307 women gave follow-up information about the outcome of the medical abortion. Of these, 207 (67.4%) women were 9 weeks or less pregnant, 71 (23.1%) were 10, 11 or 12 weeks pregnant, and 29 (9.5%) women were 13 weeks or more pregnant. There was a significant difference in surgical intervention rates after the medical abortion (19.3% at <9 weeks, 15.5% at 11-12 weeks and 44.8% at >13 weeks, p=.06). However, 42.2% of the women who had a surgical intervention had no symptoms of a complication. CONCLUSION: There is large need for medical abortion in Brazil. Home use of mifepristone and misoprostol provided through telemedicine is safe and effective. However, after 13 weeks gestation, there is an increased risk of surgical intervention that may be due to the regimen used and local clinical practices in Brazil. IMPLICATIONS: The current study shows that there is an unmet need for medical abortion in Brazil, a country with legal restrictions on access to safe abortion services. Telemedicine can help fulfill the need and self administration of medical abortion is safe and effective even at late first trimester abortion. Prospective trials are needed to establish safety, effectiveness and acceptability of home use of medical abortion beyond 12 weeks of pregnancy.


Assuntos
Aborto Induzido , Telemedicina , Aborto Induzido/estatística & dados numéricos , Adolescente , Adulto , Brasil , Feminino , Humanos , Internet , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Acta Obstet Gynecol Scand ; 91(2): 226-31, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21950492

RESUMO

OBJECTIVE: Analysis of factors influencing surgical intervention rate after home medical termination of pregnancy (TOP) by women in countries without access to safe services using the telemedical service 'Women on Web'. DESIGN: Cohort study. SETTING: Women with an unwanted pregnancy less than nine weeks pregnant who used the telemedicine service of Women on Web between February 2007 and September 2008 and provided follow-up information. SAMPLE: Women who used medical TOP with a known follow up. METHODS: Information from the online consultation, follow-up form and emails was used to analyze the outcome of the TOP. MAIN OUTCOME MEASURES: Ongoing pregnancy, reason for surgical intervention, perceived complications and satisfaction. RESULTS: Of the 2 323 women who did the medical TOP and had no ongoing pregnancy, 289 (12.4%) received a surgical intervention. High rates were found in Eastern Europe (14.8%), Latin America (14.4%) and Asia/Oceania (11.0%) and low rates in Western Europe (5.8%), the Middle East (4.7%) and Africa (6.1%; p=0.000). More interventions occurred with longer gestational age (p=0.000). Women without a surgical intervention more frequently reported satisfaction with the treatment (p=0.000). CONCLUSIONS: The large regional differences in the rates of reported surgical interventions after medical TOP provided by telemedicine cannot be explained by demographic factors or differences in gestational length. It is likely that these differences reflect different clinical practice and local guidelines on (incomplete) abortion rather than complications that genuinely needed surgical intervention. Surgical interventions significantly influenced womens' views on the acceptability of the TOP.


Assuntos
Aborto Induzido/métodos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Telemedicina , Abortivos não Esteroides/administração & dosagem , Abortivos Esteroides/administração & dosagem , Aborto Induzido/efeitos adversos , Aborto Induzido/estatística & dados numéricos , Adolescente , Adulto , Feminino , Seguimentos , Idade Gestacional , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Avaliação de Resultados em Cuidados de Saúde , Satisfação do Paciente/estatística & dados numéricos , Gravidez , Estudos Prospectivos , Autoadministração , Inquéritos e Questionários , Adulto Jovem
15.
Womens Health Issues ; 21(4): 259-64, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21712143

RESUMO

PURPOSE: U.S. military women and dependents have few options for abortion when facing an unintended pregnancy overseas. Federal law prohibits the use of Department of Defense facilities and funds for abortion except when the woman's life is at risk, and privately funded abortions are permitted at military facilities only if a pregnancy is the result of rape or incest. The purpose of this study was to explore military women's experiences seeking abortion care during overseas deployment. METHODS: We reviewed routine consultation data and user queries from an online service providing information about medication abortion. Information received between September 2005 and December 2009 from U.S. military women and dependents overseas was included. All women gave consent for anonymous use of their data, which were analyzed qualitatively for themes related to experiences seeking abortion. FINDINGS: Data were analyzed for 130 women, including 128 women in the U.S. military and 2 military dependents. Women reported facing numerous challenges accessing abortion overseas, including legal and logistical barriers to care in-country, and real or perceived difficulties accessing abortion elsewhere owing to confidentiality concerns, fear of military reprimand for the pregnancy, and the narrow timeframe for early abortion. With no perceived alternatives, some women considered unsafe methods to terminate the pregnancy themselves. CONCLUSION: U.S. servicewomen overseas lack access to safe abortion services, which may place their health and careers in jeopardy. These women should have the same rights to abortion care as women living in the United States.


Assuntos
Aborto Induzido , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Instalações Militares , Militares , Aborto Induzido/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Gravidez , Gravidez não Planejada , Gravidez não Desejada , Estados Unidos , Adulto Jovem
16.
Reprod Health Matters ; 10(19): 180-3, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12369324

RESUMO

Women on Waves was founded to contribute to the prevention of unwanted pregnancy and unsafe abortions throughout the world by direct action. Because national penal laws, including those governing abortion, generally extend only as far as territorial waters (12 miles), Women on Waves made plans to provide reproductive health services on a ship with a mobile clinic, including abortions, outside the territorial waters of countries where abortion is illegal. We went to Ireland first because it was nearby and there was a dedicated pro-choice community with immediate interest in and commitment to the project. Although we encountered problems that meant we could not do abortions, we were contacted by more than 300 women in five days and provided reproductive health information, contraception, workshops and information on where to obtain legal abortions in Europe. In many parts of the world an anti-abortion backlash is taking place. To safeguard our reproductive rights in the face of anti-abortion activities, it is crucial to recapture a pro-active, pro-choice role. Women on Waves helped to make visible the need for legal abortion services in Ireland, and the extensive class and other differences between women able to access abortions abroad and those who could not. We are currently attempting to resolve our status under Dutch law, but until women everywhere have the right to reproductive freedom, we will continue to make waves.


Assuntos
Aborto Induzido/legislação & jurisprudência , Defesa do Paciente , Navios , Direitos da Mulher , Feminino , Humanos , Irlanda , Países Baixos , Gravidez
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