WHO recommends telemedicine as an alternative to in-person abortion care
Telemedicine constitutes a form of health service delivery where providers and beneficiaries are separated in distance, and has the potential to increase access to safe abortion worldwide. The World Health Organization’s (WHO) 2022 Abortion Care Guideline recommends using telemedicine approaches as an alternative to in-person interactions for provision of medical abortion.
Abortion pills in our hands: Self-management and telemedicine abortion
The activism and science around abortion pills have long been arguing against the overregulation of abortion medication. Research has adamantly shown that self-management of abortion within first trimester (12 weeks) is safe and effective, and using telemedicine as safe abortion care may bring along significant benefits, increasing access to safe abortion and ensuring patient-centred abortion care. Previously, WHO has recommended self-care interventions on safe abortion and suggested that medical abortions up to 12 weeks can be self-managed by individuals themselves without the direct supervision of a medical practitioner. WHO suggests that self-management of medical abortion is non-invasive and cost-effective, and has the potential of contributing to bodily autonomy by giving a sense of control over the abortion process. In fact, all medical abortions are self-managed abortions given the fact that the medical abortion process requires very little medical supervision and involves a small risk for further medical attention. Telemedicine extends access to safe abortion and also reinforces the potential of abortion pills by supporting autonomy in abortion care. This may be of more importance for restrictive settings where individuals have to navigate through prohibitive laws, arbitrary barriers, abortion stigma, and protests in front of clinics. While recommending self-management and telemedicine abortion, WHO recommends against ultrasound scanning as a prerequisite for providing abortion services.
Women on Web: lessons learned
Women on Web was one of the first telemedicine abortion services to operate worldwide. Over 15 years, we have continually reshaped our model of care as per women’s needs and preferences. In this regard, we reiterate the emphasis WHO puts on “service-delivery approaches to be co-created with the people who will benefit from the intervention” and on the necessity to “test and adopt” the approaches as per the local context. There is no one ideal model for abortion care provision and indeed, telemedicine may not be preferred by all. However, offering multiple and agile service-delivery options would enable individuals to choose the services that correspond to their needs and preferences. This approach is paramount and represents an important shift towards patient-centred abortion care. Given that abortion is a time-sensitive matter, abortion services should be as close as possible to abortion seekers. In our work, we have seen tremendous advantages of translating abortion information in local languages and using a variety of service delivery methods, including hotlines and instant messaging.
While we have seen significant benefits of telemedicine in increasing access to safe abortion, even in countries where abortion is restricted, we have also encountered challenges. Access to telemedicine hinges on search engines and digital platforms that heavily rely on algorithms and artificial intelligence (AI) technologies. Our experience has shown that algorithms and AI technologies maintain gender bias and perpetuate gender discrimination online, resulting in censorship of abortion information and services. As we welcome the WHO recommendations on telemedicine abortion, we also call for further attention to the interplay of abortion access and digital rights. Now that telemedicine is recommended as a standard model for abortion care, it is fundamental that abortion rights groups engage in work around digital rights and against online censorship, misinformation and make demands for ethically responsible and anti-discriminatory design and use of artificial intelligence.
Going forward: Advance and over the counter provision of abortion pills
Medical abortion pills constitute essential medicines and are listed among the minimum medicine needs for a basic health-care system. However, we observe that abortion pills are still not approved and registered in many countries. Moreover, where they are approved, dispensing regulations are so strict that they hinder and obstruct access to safe abortion. These restrictions include requirements to take the pills in-presence of a medical practitioner or in a clinic, which have been a major barrier for the implementation of telemedicine in safe abortion care.
There is a growing consensus and a wealth of evidence outlining how restrictions on abortion pills are not medically necessary. In 2022, Women on Web started advance provision of abortion pills to make access to abortion pills as easy as possible. It is a service that is evidence-based and enables individuals to access abortion on their own terms. With this new service, individuals can request abortion pills before an unwanted pregnancy and take them as soon as they discover they are pregnant. Advance access to the medicines therefore expands the window of care and mitigates the impact of legal restrictions, unnecessary medical requirements, and other financial and logistical access barriers. It is a way for individuals to feel prepared and protected and it is an opportunity to imagine a future where abortion pills are available over the counter and on hand in case of unwanted pregnancies.