Demand for self-managed online telemedicine abortion in eight European countries during the COVID-19 pandemic: a regression discontinuity analysis
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Abstract
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.
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SciScore for 10.1101/2020.09.15.20195222: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:An important limitation, however, is that there are of course other pathways to abortion outside the formal healthcare setting in Europe, including alternative sources of mifepristone and misoprostol, and non-medication methods. Thus, we cannot measure all demand for self-managed abortion during the pandemic. We also lack nuanced insight …
SciScore for 10.1101/2020.09.15.20195222: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:An important limitation, however, is that there are of course other pathways to abortion outside the formal healthcare setting in Europe, including alternative sources of mifepristone and misoprostol, and non-medication methods. Thus, we cannot measure all demand for self-managed abortion during the pandemic. We also lack nuanced insight into the exact reasons underlying changes in requests to WoW for any particular country. It is important to note that in the two countries where we observed no increases in requests, people likely still encountered challenges to accessing abortion services.22 Future qualitative work could address this important knowledge gap. Our results may reflect two distinct phenomena. First, in some countries, more people may be seeking abortion through all channels during the pandemic. The decision to end a pregnancy could be due to the perception of risk posed by COVID-19, reduced access to pre-natal care, and limited social support during lockdowns.23 Additionally, decision-making could be influenced by the economic downturn COVID-19 has precipitated, with many people facing unemployment or financial losses.24 It has also been suggested that social distancing policies may increase rates of unintended pregnancy due to increased time spent at home with a partner or reduced access to contraception.25 Second, the observed increases in requests may represent a shift in demand from in-clinic abortion to self-managed abortion using online telemedicine. In co...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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