COVID-19 impacted our lives a lot. Working from home became common sense, losing a dear family member and making hospital appointments became incredibly difficult. In Sexual Reproductive Health, Marie Stopes International (MSI) expected that up to 9.5 million females would lose access to contraception and safe abortion services due to COVID. It could lead to 2.7 million unsafe abortions and more than 10,000 pregnancy-related deaths [1]. Inspired by the guest lecture of Kelly Hunter, a DGHI Doctoral Scholar and PhD candidate in Political Science, about her research on the impact of the Global Gag Rule and COVID-19 on women’s sexual and reproductive health in Kenya [2], I want to look at how COVID-19 and development of telemedicine impacted sexual and reproductive health in high-income countries, such as the United States and Great Britain.
By its WHO definition, telemedicine utilises internet and communication technology (ICT) in healthcare practice [3]. A wide array of information collected through various technologies helps decrease the cost of care while increasing patients’ convenience. Since the concept of social distancing was spread around the globe due to the COVID-19 pandemic, there was an increase in demand for telehealth and virtual counselling from both care providers and patients. CDC announced that telehealth visits increased by 154% during the first quarter of 2020 compared to the same period in 2019 [4]. Considering a striking increase of telehealth in outpatient care, did the quality of care and effectiveness remain the same when mothers terminate their pregnancy with prescribed medications over the phone? In other words, is telemedicine helpful to reduce the unsafe abortion rate? The answer is yes, and I want to present two recently published journals from California and the United Kingdom to justify reasons.
In the United States, Upadhyay et al. (2021) investigated the effectiveness of a virtual abortion medication provider clinic called Choix in California [5]. California is one of 28 states where clinicians can prescribe abortion pills without in-person hospital visits and mail the medication. After prescribing medicine, there were three follow-ups: confirming medication administration, 3-day assessment, and a 4-week home pregnancy test. In conclusion, researchers found 95% efficacy with telehealth abortion service, similar to the level of in-person service.
Similarly, the Royal College of Obstetricians and Gynaecologists in the UK built a ‘telemedicine-hybrid’ model for abortion, which includes ‘no-test telemedicine’ (no required ultrasonography before prescription), along with a decision-making flowchart for an early medical abortion without ultrasound [6]. Researchers measured outcome in four dimensions: access (waiting time and gestation at treatment), effectiveness (success rate of abortion), safety (proportion of adverse events), and acceptability (feedbacks from patients). A notable outcome was a ‘mean waiting time to treatment’, which was decreased by 4.2 days with the telemedicine-hybrid model, while there were no differences in adverse events or success rate. These two researchers showed that telemedicine enhanced the quality of abortion care during the COVID-19 pandemic.
Despite its convenience and high efficiency, there are still areas of concern in telehealth medication abortion, such as drug abuse and lack of post-abortion care. Although Upadhyay et al.’s (2021) research had follow-up messages or contacts upon abortion, they did not measure the quality of follow-up assessment. Also, while British researchers found demographic characteristics in their patient cohorts, they did not address possible barriers to access to telemedicine due to low socioeconomic status. Since we are still in the middle of the pandemic, there is plenty of room for further research on the relationship between telemedicine and safe abortion, but these researchers show a promising future of safe abortion with telemedicine.
References
[1] Cousins, S. (2020). COVID-19 has “devastating” effect on women and girls. The Lancet, 396(10247), 301–302. https://doi.org/10.1016/S0140-6736(20)31679-2
[2] Hunter, K., Hubner, S., & Kuczura, E. (2021). “If you don’t help me, I’m going to take my life”: The devastating impact of the US’s global gag rule and the COVID-19 pandemic on women’s sexual and reproductive health in Kenya. International Feminist Journal of Politics, 23(2), 350–357. https://doi.org/10.1080/14616742.2021.1896372
[3] WHO. (September 28, 2021). Safe abortion in the context of COVID-19: Partnership, dialogue and digital innovation. Retrieved 26 September 2021, from https://www.who.int/news/item/28-09-2021-safe-abortion-in-the-context-of-covid-19-partnership-dialogue-and-digital-innovation
[4] Koonin, L. M., Hoots, B., Tsang, C. A., Leroy, Z., & Farris, K. (2020). Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic—United States, January–March 2020. MMWR. Morbidity and Mortality Weekly Report, 69. https://doi.org/10.15585/mmwr.mm6943a3
[5] Upadhyay, U. D., Koenig, L. R., & Meckstroth, K. R. (2021). Safety and Efficacy of Telehealth Medication Abortions in the US During the COVID-19 Pandemic. JAMA Network Open, 4(8), e2122320. https://doi.org/10.1001/jamanetworkopen.2021.22320[6] Aiken, A., Lohr, P., Lord, J., Ghosh, N., & Starling, J. (2021). Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: A national cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 128(9), 1464–1474. https://doi.org/10.1111/1471-0528.16668