TRANSGENDER, NONBINARY, AND GENDER-EXPANSIVE EXPERIENCES WITH TELEHEALTH MEDICATION ABORTION AND IMPLICATIONS FOR HEALTH EQUITY IN THE US

Abstract

Objectives

Transgender, nonbinary, and gender-expansive (TGE) patients need abortion care. However, little is known about TGE patients’ experiences with telehealth abortion care, a growing mode of abortion service post-Dobbs.

Methods

We conducted 13 in-depth interviews with TGE patients of three US virtual abortion clinics — Choix, Hey Jane, and Abortion on Demand — who obtained telehealth abortion care between April 2021 and January 2024. Interviews were transcribed and analyzed abductively using Dedoose.

Results

The direct-to-patient telehealth model for abortion reduced barriers for trans and nonbinary patients. Many interviewees appreciated the ability to avoid entering an abortion clinic, a space typically associated with “women’s health.” Telehealth allowed patients to circumvent potential gender discrimination or uncomfortable gender-related interactions with providers and other patients, which they expected from in-person care. Patients appreciated the option to either report their preferred name and/or pronouns on intake forms or to not disclose their gender identity altogether — particularly for those who received care through asynchronous secure messaging without any face-to-face interaction. TGE Interviewees also appreciated the increased privacy, anonymity, reduced logistics, and speed of telehealth.

Conclusions

Telehealth abortion care is highly acceptable and beneficial for TGE patients, as they benefit from an at-home experience coupled with reduced gender discrimination. Findings can help direct gender-affirming abortion care in-person and via virtual clinics.