10-year evaluation of the use of medical abortion through telemedicine: a retrospective cohort study

H. Nortén*, O. Ilozumba, J. Wilkinson, K. Gemzell-Danielsson, R. Gomperts

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objective: To provide a descriptive overview and evaluate changes in the use and outcome of abortions provided worldwide by telemedicine in the past 10 years. Design: Retrospective cohort study. Setting: Multi-country. Population/Sample: 30 344 women who completed the follow-up survey of the telemedical abortion service Women on Web from January 2009 till January 2020. Methods: Analyses of follow-up surveys, binary logistic regressions to test the association between year and outcomes. Main outcome measures: Rate of complete abortions, surgical interventions, ongoing pregnancies, blood transfusions per year, socio-economic situation, knowledge on medical abortion, acceptability of receiving service, appropriateness of method and the likelihood of recommending the service to a friend. Results: Medical abortions were provided to 81 683 women, of whom 30 344 (37.2%) completed the follow-up survey. In total, 26 076 women reported doing the medical abortion, of whom 1.5% reported an ongoing pregnancy, 10.2% a surgical intervention and 0.6% a blood transfusion. Acceptability of the service was 99%, and 59.2% of the users reported previous knowledge of medical abortion. We found a significant increase in complete abortions in 2019 (odds ratio 1.92; 95% CI 1.59–2.31) and decrease in surgical interventions (odds ratio 0.49; 95% CI 0.40–0.60) compared with 2009. Conclusion: Low follow-up rates present a limitation in analysing trends in telemedical abortion usage. However, our findings suggest that it is a highly acceptable method around the world and that there has been an increase in complete abortions by telemedical abortions and a decrease in surgical interventions in the last 10 years. Tweetable abstract: In the last 10 years, there has been an increase in complete abortions and decrease in surgical interventions of telemedical abortion.

Original languageEnglish
Pages (from-to)151-159
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume129
Issue number1
Early online date21 May 2021
DOIs
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
HN and IO have none to declare. JW is supported by a Wellcome Institutional Strategic Support Fund award (204796/Z/16/Z) outside the submitted work and declares that publishing research benefits his career. KGD has served as an ad hoc speaker and/or member of advisory boards for Exelgyn, Campus Pharma, HRA Pharma, MSD/Merck, Bayer AG, Exeltis, Mithra, Natural Cycles, Gedeon Richter and Azanta, and her clinic has received support for clinical trials from MSD/Merk, Bayer AG, Myovant, and Removaid outside the submitted work. RG is the founder and director of Women on Web. Completed disclosure of interests forms are available to view online as supporting information.

Publisher Copyright:
© 2021 John Wiley & Sons Ltd.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • medical abortion
  • mifepristone
  • self-managed abortion
  • telemedicine

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