10-year evaluation of the use of medical abortion through telemedicine: a retrospective cohort study.

Objective: To provide a descriptive overview and evaluate changes in the use and outcome of abortions provided worldwide by telemedicine in the past 10 years.

Design: Retrospective cohort study.

Setting: Multi-country.

Population/sample: 30 344 women who completed the follow-up survey of the telemedical abortion service Women on Web from January 2009 till January 2020.

Methods: Analyses of follow-up surveys, binary logistic regressions to test the association between year and outcomes.

Main Outcome Measures: Rate of complete abortions, surgical interventions, ongoing pregnancies, blood transfusions per year, socio-economic situation, knowledge on medical abortion, acceptability of receiving service, appropriateness of method and the likelihood of recommending the service to a friend.

Results: Medical abortions were provided to 81 683 women, of whom 30 344 (37.2%) completed the follow-up survey. In total, 26 076 women reported doing the medical abortion, of whom 1.5% reported an ongoing pregnancy, 10.2% a surgical intervention and 0.6% a blood transfusion. Acceptability of the service was 99%, and 59.2% of the users reported previous knowledge of medical abortion. We found a significant increase in complete abortions in 2019 (odds ratio 1.92; 95% CI 1.59-2.31) and decrease in surgical interventions (odds ratio 0.49; 95% CI 0.40-0.60) compared with 2009.

Conclusion: Low follow-up rates present a limitation in analysing trends in telemedical abortion usage. However, our findings suggest that it is a highly acceptable method around the world and that there has been an increase in complete abortions by telemedical abortions and a decrease in surgical interventions in the last 10 years.

Tweetable Abstract: In the last 10 years, there has been an increase in complete abortions and decrease in surgical interventions of telemedical abortion.