DOES PSYCHOSOCIAL BURDEN DIFFER WHEN ACCESSING MEDICATION ABORTION USING NO-TEST, TELEHEALTH CARE COMPARED TO IN-PERSON CARE WITH ULTRASOUND?

Objectives

We aimed to explore whether no-test, telehealth abortion care reduces the psychosocial burden of abortion care-seeking.

Methods

As part of a study on the safety and effectiveness of telehealth abortion care, from May 2021-March 2023, we surveyed and abstracted medical record data for 583 patients obtaining medication abortion ≤ 70 days gestation, English- or Spanish-speaking, ages ≥ 15 years at four abortion clinic organizations in six US states. We assessed three psychosocial burden dimensions (structural challenges, five items, α=0.80; lack of autonomy, three items, α=0.73; and others’ reactions to the pregnancy, two items, α=0.88, range 0–3) by study group (1) telehealth and mailing medications, (2) no-test and pick-up medications, and (3) in-person with ultrasound.

Results

A total 403 enrolled participants completed psychosocial burden items. In adjusted analyses, telehealth by mail was associated with fewer structural challenges than in-person care (-0.12, 95% CI -0.23,-0.00), mostly due to less difficulty traveling for care (24% vs 32%, p<0.05). While mean lack of autonomy scores did not differ by study group, the telehealth by mail (11%) and no-test and pick-up (12%) groups were less likely to feel forced to wait for the abortion after making the decision, when compared to the in-person with ultrasound group (22%, p<0.05). The no-test and pick-up group (35%) was also less likely to be worried about friends/family members’ reaction to the pregnancy than the in-person care group (42%, p<0.05).

Conclusions

No-test, telehealth medication abortion care may reduce the psychosocial burden of abortion-seeking, in particular the burden of travel and feeling forced to wait for care.