Telehealth Medication Abortion in Restrictive Policy Contexts

• In Event: Social Equity in Health Care: Policy, Access, and Digital Systems

Abstract

Background: Following the overturning of Roe vs. Wade, state-level abortion bans, parental involvement laws, and structural barriers to abortion care have created a complicated policy landscape for adolescents under 18 years old seeking abortion. Because of such obstacles, adolescents may circumvent state-level policy restrictions and obtain medication abortion from online sources. We aimed to understand their individual motivations for obtaining medication abortion from one online service. Telehealth medication abortion represents a technology-enabled pathway through which adolescents may seek care within restrictive policy contexts.Methods: We conducted a mixed-methods study among adolescent minors who requested medication abortion between July 1, 2022, and November 30, 2022, from a service providing asynchronous clinician consultation and medication dispensed by mail to people in all 50 US states. We examined demographic characteristics, state-level policy context, and reasons for request. We conducted a content analysis of a sub-sample of anonymized email communications.Results: Over a 5-month period 558 adolescents requested medication. The most frequently selected motivations were: I would rather keep my abortion private (66%); I would be more comfortable at home (64%); and I need to keep my treatment a secret from my partner/family (64%); Pills at home are more affordable (47%); I prefer to take care of my own treatment (47%); and I want to have my partner/friend with me (45%). In email communication adolescents expressed an urgent need for abortion and articulated additional barriers including the high cost of the service and lack of access to a credit card or digital payment methods. These findings provide additional context on how adolescents navigate available care options within existing structural constraints.Conclusions: Results provide insights into why adolescents in the US pursue online medication abortion services and raise the need to address state-level restrictions including telehealth bans, parental involvement laws, and gestational limits on abortion care provision. These findings further inform policy discussions related to access to abortion care across different service delivery modalities.

Author

• Dana Johnson, University of Wisconsin-Madison
  Presenting Author