Should COVID-specific arrangements for abortion continue? The views of women experiencing abortion in Britain during the pandemic
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Abstract
During the COVID-19 pandemic, the British governments issued temporary approvals enabling the use of both medical abortion pills, mifepristone and misoprostol, at home. This permitted the introduction of a fully telemedical model of abortion care with consultations taking place via telephone or video call and medications delivered to women’s homes. The decision was taken by the governments in England and Wales to continue this model of care beyond the original end date of April 2022, while at time of writing the approval in Scotland remains under consultation.
Methods
We interviewed 30 women who had undergone an abortion in England, Scotland or Wales between August and December 2021. We explored their views on the changes in abortion service configuration during the pandemic and whether abortion via telemedicine and use of abortion medications at home should continue.
Results
Support for continuation of the permission to use mifepristone and misoprostol at home was overwhelmingly positive. Reasons cited included convenience, comfort, reduced stigma, privacy and respect for autonomy. A telemedical model was also highly regarded for similar reasons, but for some its necessity was linked to safety measures during the pandemic, and an option to have an in-person interaction with a health professional at some point in the care pathway was endorsed.
Conclusions
The approval to use abortion pills at home via telemedicine is supported by women having abortions in Britain. The voices of patients are essential to shaping acceptable and appropriate abortion service provision.
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SciScore for 10.1101/2022.02.17.22271080: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Inclusion criteria were: age 16 and over, able to give informed consent, UK-resident, and choosing abortion for reasons other than fetal anomaly.
IRB: Ethical approval: Ethical approvals were obtained from the Research Ethics Committees of the British Pregnancy Advisory Service (reference 2021/02/WEL), the London School of Hygiene & Tropical Medicine (reference 22761) and the NHS (reference 21/LO/0236).Sex as a biological variable Sampling: A purposive sample of 30 women with recent (past 2-8 weeks) experience of abortion were recruited between July and December 2021 from six sites: three independent-sector services commissioned by the NHS (a telemedicine hub in the North of England … SciScore for 10.1101/2022.02.17.22271080: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Inclusion criteria were: age 16 and over, able to give informed consent, UK-resident, and choosing abortion for reasons other than fetal anomaly.
IRB: Ethical approval: Ethical approvals were obtained from the Research Ethics Committees of the British Pregnancy Advisory Service (reference 2021/02/WEL), the London School of Hygiene & Tropical Medicine (reference 22761) and the NHS (reference 21/LO/0236).Sex as a biological variable Sampling: A purposive sample of 30 women with recent (past 2-8 weeks) experience of abortion were recruited between July and December 2021 from six sites: three independent-sector services commissioned by the NHS (a telemedicine hub in the North of England and in-person clinics in London and South West England); and NHS sites in Scotland, Wales and England (London). Randomization not detected. Blinding not detected. Power Analysis not detected. 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:Strengths and limitations: Our study is unique in being the only Britain-wide study examining women’s views on the current COVID-related arrangements and policies for abortion with participants drawn from both independent providers of abortion care and NHS facilities. The methodological approach taken allowed women’s voices to be heard directly, providing access to their priorities and preferences, and so enhancing understanding of the meaning and significance of abortion experience for them. A weakness of this analysis is that it did not include women aged under 20, thereby missing the opportunity to understand specific challenges or benefits in this age group. Further, women volunteering for interview may have occupied more extreme ends of the satisfaction spectrum, introducing a bias towards more positive or more negative views and experiences. Contextualisation and interpretation: The COVID pandemic has been an impediment to sexual and reproductive health services but it has also provided the impetus to new ways of working, an effect described as the ‘COVID-19 silver lining’.(11) In the context of abortion provision it has served to provide what might be seen as a ‘natural experiment’ in which the merits of a new model of care can be observed in the general population. Evaluation of the use of mifepristone as well as misoprostol at home pre-dates the COVID pandemic and is based on earlier experimental and quasi-experimental studies, and those based on selective samples su...
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.
Results from scite Reference Check: We found no unreliable references.
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