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  • Photo du rédacteurCharlotte Puechmaille

The role of telemedicine in abortion care

Dernière mise à jour : 3 janv. 2023



Women may face various health challenges in their lives that we started to cover in previous posts: infertility, menopausal symptoms, birth control side effects, chronic conditions like endometriosis


In this article, we will focus on abortion, a common healthcare procedure that concerns 29% of pregnancies worldwide. Still restricted, 700M of women of reproductive age cannot access safe interventions.


How accessible is abortion care today in the world? What is telemedicine contribution?

How will the U.S. situation potentially evolve after the end of Roe?


A note to conscientious readers:

  • While I use the term “women” in this article for simplicity, I refer to all individuals with uterus and ovaries, including some transgender men, non-binary people, intersex people or people with variations in sex characteristics.

  • Additionally, I will highlight abortion care solutions in this article. Should you need more information on these solutions (for instance, indications for use), please refer to the web links. This article shall not be interpreted in any manner as a medical prescription or medical advertising.

1. Why it matters ?


Unsafe abortion is a leading – but preventable – cause of maternal deaths and morbidities.


According to the World Health Organization (WHO), around 73 million induced abortions occur each year globally.


This healthcare procedure is common as 61% of unintended pregnancies and 29% of all pregnancies end in induced abortion.


Around 45% of all abortions are unsafe, of which 97% take place in developing countries.


In the U.S., according to Hey Jane start-up, “1 in 4 people with uteruses will have an abortion by age 45”. In France, 2.8% of women aged 20-29 had an abortion in 2019.


As a reminder, abortion is “a procedure to end a pregnancy” and should be carried out as early as possible for safety and medical reasons.


This healthcare intervention can be managed by a wide range of health workers using medication or a surgical procedure.


Most abortions are carried out before 24 weeks of pregnancy.


In the first 12 weeks of pregnancy, the WHO outlines that “a medical abortion can also be safely self-managed by the pregnant person outside of a health care facility (e.g., at home)”.


2. How accessible is abortion care today?


The inability to access safe and legal abortion care impacts 700 million women of reproductive age worldwide. Medication abortion is on the rise facilitated by telemedicine in some countries.


The right to safe and legal abortion is a fundamental human right protected under numerous international treaties and national-level constitutions.


Comprehensive abortion care has been included in the list of essential health care services published by the World Health Organization in 2020.


What % of women live in countries that allow abortion?


In 2021, according to the Center for Reproductive Rights (CRR) :

  • 970 million women (59% of women of reproductive age) live in countries that allow abortion

  • 41% of women live under restrictive laws

What are the consequences of restrictive laws?


The CRR precises that “legal restrictions on abortion do not result in fewer abortions, instead they compel women to risk their lives and health by seeking out unsafe abortion care.”


Unsafe abortions cause around 39 000 deaths every year and represent between 4.7% and 13.2% of all maternal deaths worldwide. They result in millions more women hospitalized with complications, most of these deaths being concentrated in lower-income countries.


The growing prevalence of medication abortion


The WHO abortion care guidelines highlight that medical abortionhas revolutionized access to quality abortion care globally”.


In countries allowing abortion, the use of medicines for abortion has increased during Covid-19 pandemic as in-clinic interventions were limited.


In the United States, the Guttmacher Institute reported that medication abortion accounted for 54% of all abortions in 2020 (vs 39% in 2017).


Allowed in 2000, medication abortion is authorized by the FDA for use in the first 10 weeks of pregnancy.


In the past years, several U.S. providers like Hey Jane, Choix, Just the Pill, have developed telemedicine services to supply FDA-approved abortion pills by mail to pregnant persons in U.S. states allowing it.


Their development was facilitated by the FDA decision in December 2021 to permanently allow patients to receive abortion medication by mail as long as other restrictions are met (including a prescription by a certified health provider).


Following a telehealth appointment with a board-certified physician, if eligible criteria are met, patients are prescribed and mailed abortion pills directly to their homes. A medical follow-up is provided if they need it.


For pregnant persons, advantages of this telemedicine approach can be:

  • lower price ($250 on average vs $500 in person according to Hey Jane estimates)

  • privacy

  • accessibility as this health procedure is done from the comfort of their home (vs in-clinic intervention)


On an international level, organizations such as Aid Access also operate to provide abortion services to patients worldwide. Their service includes online consultations with physicians, prescriptions for abortion pills and shipping from a pharmacy in India.


In France, abortion care-related telehealth appointments have been permanently allowed since February 2022. Prescribed abortion pills can be picked up at a local pharmacy.


3. What could be the consequences of the Roe V. Wade overturning in the U.S. ?


Although they will face a stricter regulatory environment, digital abortion clinics should continue their expansion. Digital health data privacy will be critical to protect pregnant persons.


In the hours after the Supreme Court released its decision, several at-home abortion pill start-ups observed an increase in demand.


According to a New York Times article, Just the Pill observed4 times the usual daily number of appointment requestsand “many came from patients in Texas and other states that quickly halted abortions after the court ruling”.


All of them are claiming that they will do their maximum to continue their operations and increase abortion access to patients in need all over the country.


A large number of US-based FemTech start-ups mobilized on social media to share abortion resources to their communities (from web links to abortion funds to mental health support platforms…).


Some of them, like Loom, even shared digital privacy counseling to their audience.

Citizens voiced their concerns on social media that US authorities could use their private health data against them (those generated by online searches, GPS locations, period-tracking mobile applications…).


The University of Baltimore Law Review had published an article in October 2020 about the risk that “technology can exponentially accelerate the criminal exposure of pregnant people, their providers, and anyone who assists them”.


“What will you do if you are legally made to surrender our health data information through a subpoena?” asked several users to cycle tracking applications Flo Health, Clue and Natural Cycles on Instagram.


In a critical legal case, they fear that their private health data could be disclosed and represent digital evidence of their potential pregnancy and abortion.


To answer questions, the three companies made statements ensuring they would protect users’ private health information:

  • Both Clue and Natural Cycles reminded their users that as Europe-based companies, they were following the GDPR rules to protect their US users’ data

  • Flo Health announced that it was working on a new feature called “Anonymous Mode”, an option that will allow users to access the Flo app anonymously “without providing their name or email address”

  • The Wall Street Journal also reported that Natural Cycles was “currently working on a completely anonymous experience

As women’s health rights are challenged, the respect of data privacy will be even more important in the future. That will be particularly the case for FemTech applications holding sensitive data on patients living in countries that restrict access to vital healthcare services.


Conclusion


Last week’s news was particularly shocking to many of us in the FemTech industry.


We remain hopeful that organizations will continue to mobilize themselves to support women’s health rights.


Thank you for reading this article.


Charlotte Puechmaille from FemTech Now


This article was initially published on the FemTech Now Linkedin page on July 1, 2022.


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