This time last year, as much of the world went into lockdown, access to sexual and reproductive healthcare was put at risk. With rapid innovation and evidence-based policy decisions, telemedicine was launched in the UK and South Africa, protecting access to early medical abortion care via at-home services.
One year on, we take a look at the impact that telemedicine has had across MSI’s programmes, and what the global body of evidence – and clients directly - are telling us about whether telemedicine should remain available as a permanent option.
In April 2020, MSI launched our UK telemedicine programme, allowing tele-consultations and the self-administration of medical abortion pills – mifepristone and misoprostol – from home. Our clinics remained open for those who needed or would prefer face-to-face care, but for the first time in UK history, eligible early medical abortion clients were able to administer both stages of their medical abortion from home, accessing a virtual consultation to ensure their suitability, before receiving their medical abortion pills by post.
Prior to the pandemic, global evidence from both MSI’s programme in Australia and a review of programmes by colleagues at the WHO had shown telemedicine to be just as safe, effective and acceptable to clients as in-facility care. The introduction of telemedicine in the UK, from MSI UK and our partners at BPAS and NUPAS, provided a unique opportunity to add to this global body of evidence, tracking the outcomes of a programme delivered at scale. With this, two ground-breaking studies have been published revealing outcomes even more compelling than anticipated.
The first study – the largest ever on abortion care in the UK – was published in BJOG, showing that the services were just as safe and effective as in-facility care. The study was led by the University of Texas and featured the outcomes of more than 50,000 early medical abortions, provided by MSI UK, BPAS and NUPAS. It found that the effectiveness of the treatment remained consistent for abortions carried out through the traditional service and the telemedicine service. It also significantly improved waiting times for clients, as the time from when a client received their consultation to when they received treatment was reduced from an average of 10.7 days to 6.5 days.
While it was important to evidence that the services were safe, we also wanted to hear directly from clients about their experience of telemedicine and whether they would opt for face-to-face care instead, both during the pandemic restrictions and in the future. With that in mind, MSI Reproductive Choices published a second paper in the British Medical Journal, focused on client voices. By analysing feedback data from a sample of telemedicine clients, we revealed that at-home abortion care, via telemedicine, was the preferred choice for 8 out of 10 clients (83%) during the pandemic. Two thirds of clients shared that they would choose the route again, should they ever need an abortion in the future, even if COVID-19 were no longer an issue.
We heard that many clients preferred having their consultation over the phone, as it can feel more private and less stressful than visiting a clinic. Many people fear judgment about abortion, even from clinicians, which is worsened by the anti-abortion groups that continue to harass clients outside clinics. Many clients find it hard to leave the house without those they live with finding out why. By providing telephone consultations and medicines by post we remove these barriers, allowing clients to access confidential care in the comfort of their own homes. This provides a unique opportunity to support the most marginalised, including young women and women at risk of violence who might otherwise find it difficult to access care and support. One MSI UK telemedicine client, Sylvie, shared that her experience of accessing a medical abortion via telemedicine was ”respectful”, “compassionate” and, crucially for her, “private”.
As we know, COVID-19, and these common barriers to abortion care, are not limited to the UK. To expand access to safe, effective and confidential abortion care elsewhere, too, we have shared learnings from our UK programme to explore similar models in other MSI programmes, for example, in South Africa, where we launched our telemedicine programme in April 2020.
In South Africa, despite relatively liberal abortion laws, it is not uncommon for women to access unsafe services. Challenges in accessing safe, facility-based care continue to drive women to unsafe abortions, including an inability to travel to facilities, particularly for women living in rural regions. With the introduction of telemedicine, MSI South Africa saw an opportunity to increase access, both by protecting early medical abortion services during lockdowns, and by expanding access beyond the pandemic, particularly to women who might otherwise be unable to access care.
With the introduction of MSI South Africa’s telemedicine programme, clients can access a remote telehealth eligibility screening and consultation with a medical professional. If eligible, the client is delivered the medical abortion pills at home, along with details on how to self-administer and information on where to access follow-up care if needed. Through the scheme, over 3,200 women have accessed safe abortion care so far, including women in rural, underserved communities, with one in ten clients based in regions not previously served by MSI.
As one client shared: “I found out I was pregnant during the lockdown period. I am studying at Rhodes University and could not think of a way to get to PE [Port Elizabeth] for the service, so I was referred to telemedicine. It was a speedy service.”
It is important to remember that medical abortion via telemedicine is not the right option for everyone. For those who would prefer to access face-to-face care, for clients seeking an abortion after the first trimester of pregnancy, or, as often seen in MSI’s global programmes, for clients facing complications from a previous unsafe abortion attempt, access to facility-based care remains vital.
However, what the evidence shows is that telemedicine provides a safe and effective pathway that’s preferable to clients and must be protected. The UK government has now begun considering the evidence received through its public consultation over whether telemedicine should remain beyond the pandemic. With women and governments globally looking to the UK’s decision, we hope that ministers will listen to the resounding body of evidence - and vitally, the voices of clients - when deciding how people can access reproductive healthcare and the choices that are right for them.Back to news