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

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.

Automated summary

The study results show an increase in the rate of complete abortions and a decrease in surgical interventions for telemedical abortion in the last 10 years. Despite the limitation of low follow-up rates, it is evident that this method is highly acceptable worldwide.