JMIR Publications

ABSTRACT

Background:

Medication abortion accounts for the majority of abortions in the United States (U.S.), driven in part by growth in telehealth provision of medication abortion following the lifting of the U.S. Food and Drug Administration’s (FDA) in-person dispensing requirement for mifepristone. While research indicates high patient satisfaction with telehealth medication abortion care, research on medication abortion patients’ care preferences remains understudied.

Objective:

This paper examines the abortion care features medication abortion patients find most important by medication abortion model received (telehealth vs. in-person eligibility assessment) and examines patients’ access to technologies for telehealth care.

Methods:

From May 2021 to March 2023, we surveyed participants (eligibility criteria: <70 days’ gestation, English/Spanish-speaking, ≥15 years old) obtaining medication abortion at four clinic organizations providing care in six states in the United States. Participants rated the importance of 12 abortion care features (i.e. getting care at home, convenience, cost, safety, effectiveness, privacy, etc.) and described access to technologies required for telehealth. We compared features rated as "extremely important" by medication abortion model received (telehealth vs. in-person eligibility assessment). We used linear, logistic, and multinomial regression analyses to assess differences by model received.

Results:

Among 1,017 patients approached, 876 were eligible, 583 participants enrolled, 487 initiated a survey, 477 (242 telehealth, 235 in-person) completed survey questions regarding access to technologies for telehealth, and 397 completed questions about abortion care features. Telehealth and in-person participants similarly reported the same medication abortion care features: effectiveness (telehealth: 87.2% and in-person: 83.9%, P=.159), safety (82.5% and 81.7%, P=.683), timeliness (76.8% and 78.0%, P=.353), and privacy (78.2% and 72.0%, P=.160) as “extremely important”. Whereas, telehealth participants were more likely than in-person participants to report getting care at home (65.9% vs. 43.5%, P<.001) and having a medication abortion (62.1% vs. 51.1%, P=.01) as extremely important and less likely to report having an in-person meeting with a clinician (16.1% vs 45.7%, P<.001) and ultrasonography (15.2% vs 38.2%, P<.001) as extremely important. Features rated as extremely important were sometimes discordant with the care received (i.e., 54.1% of participants who rated the ability to get care at home without a clinic visit as extremely important ultimately had a clinic visit). Almost all participants had access to technologies required for telehealth, including a smartphone (99.0%) and WiFi (93.8%).

Conclusions:

While telehealth abortion services offer many features that people find important, the availability of both telehealth and in-person abortion care remains critical to ensuring care aligns with patient preferences. In addition to efforts focused on expanding access to telehealth medication abortion services, advocates and policymakers should continue their work to ensure access to in-person care for those who need or prefer this model.