Why Women Choose At-Home Abortion via Teleconsultation in France?: A Mixed-Method Study on Drivers of Telemedicine Abortion
Authors: Atay Hazal , Perivier Helene , Gemzell-Danielson Kristina , Guilleminot Jean , Hassoun Danielle , Hottois Judith , Gomperts Rebecca , Levrier Emmanuelle 
Published: April 2021

AbstractObjectivesIn face of the COVID-19 health emergency, France has allowed medical abortions to be performed by teleconsultation until 9 weeks of gestation. In an attempt to understand the demand and main drivers of telemedicine abortion, we analysed the requests that Women on Web (WoW), an online telemedicine abortion service operating worldwide, received from France throughout 2020.MethodsWe conducted a parallel convergent mixed-method study among 809 consultations received from France at WoW between 1 January and 31 December 2020. We performed a cross-sectional study of data obtained from the WoW consultation survey and a manifest content analysis of anonymised email correspondence of 140 women consulting with WoW helpdesk from France.ResultsWe found that women encounter macro-level, individual-level, and provider-level constraints while trying to access abortion in France. The preferences and needs over secrecy (46.2%), privacy (38.3%), and comfort (34.9%) are among the most frequent reasons for women from France to choose telemedicine abortion through WoW. The COVID-19 pandemic seems to be an important driver for resorting to telemedicine (30.6%). The lockdowns seem to have had an impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.ConclusionsThe demand for at-home medical abortion via teleconsultation increased in France during the lockdowns. However, drivers of telemedicine abortion are multi-dimensional and go beyond the conditions unique to the pandemic. Given the various constraints women continue to encounter in accessing safe abortion, telemedicine can help meet women’s preferences and needs for secrecy, privacy and comfort, while facilitating improved access to and enabling more person-centred abortion care.Tweetable AbstractAt-home abortion via teleconsultation can help meet women’s needs and preferences for privacy, secrecy, and comfort, while facilitating improved access to abortion care in France.Key MessagesThe lockdowns seem to have had an impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.While the COVID-19 pandemic was an important push factor for women to choose telemedicine, the drivers of telemedicine are multidimensional and go beyond conditions unique to the pandemic.Telemedicine can help meet women’s needs and preferences for privacy, secrecy, and comfort, while facilitating access to and enabling more person-centred abortion care in France.Funding InformationThis research was funded by a public grant overseen by the French National Research Agency (ANR) as part of the “Investissements d’Avenir” program LIEPP (ANR-11-LABX-0091, ANR-11-IDEX-0005-02) and the Université de Paris IdEx (ANR-18-IDEX-0001).Patient and public involvement statementThis public policy analysis does not involve patients or the public in the design, or conduct, or reporting, or dissemination plans of this work. However, the service that WoW provides is designed to address the priorities and experiences of people who access the service. Thus, the research questions were informed by the needs of people who rely on WoW to access abortion.Ethics approvalThe study was approved by the Regional Ethics Committee, Karolinska Institutet, Dnr 2009/2072-31/2 and Dnr 2020/05406.