Telemedicine for medical abortion service provision in Mexico: A safety, feasibility, and acceptability study

• Published in: Contraception (Stoneham) 2022-10, Vol.114, p.67-73
• Main Authors: Peña, Melanie, Figueroa Flores, Karla, Muñoz Ponce, Mariana, Facio Serafín, Diana, Camarillo Zavala, Ana María, Ruiz Cruz, César, Ortiz Salgado, Irving Geovanni, Ochoa Rosado, Yeni, Socarras, Tania, Pacheco López, Adrián, Bousiéguez, Manuel
• Format: Article
• Language: English
• ISSN: 0010-7824; 1879-0518
• DOI: 10.1016/j.contraception.2022.06.009

OBJECTIVEWe aimed to obtain evidence about the safety, acceptability, and feasibility of a direct-to-patient telemedicine medical abortion service in Mexico's private health sector. STUDY DESIGNA prospective observational one-group study to evaluate a telemedicine abortion service, referred to as TeleAborto, was conducted at three private clinics and one nonclinician community-based provider. Information about the study was provided by phone, websites, and social media. Abortion seekers were screened for eligibility and underwent any pre-abortion tests requested by the study site at services close to home. Eligible participants received packages with abortion medication, analgesics, and instructions and a remote follow-up contact was scheduled for 7 to 14 days later. Primary outcomes include abortion outcome, management of adverse events, acceptability, and feasibility measures such as package reception and follow-up contact, and challenges to get pre- and post-abortion tests. RESULTSWe conducted 581 screenings and sent 378 study packages, all successfully received, reaching abortion seekers in all 32 states. All participants took medications before 70 days gestational age as per study protocol. Abortion outcome was determined for 87% of participants (330/378); 93% (306/330) had a successful abortion without intervention and 18 with intervention; 6 individuals decided to continue the pregnancy. Participants reported high satisfaction with TeleAborto, citing convenience as their most valued aspect (85%; 264/311). CONCLUSIONSThis study showed that guided self-managed telemedicine abortion is safe, acceptable, and feasible in Mexico. The model has the potential to close the access gap for indigenous and rural populations, and those that rely on public sector services. IMPLICATIONSThe findings contribute evidence in support of telemedicine models for early medical abortion, demonstrating the feasibility of a self-management protocol implemented with supportive health care providers and the potential for a broad geographical reach in Mexico.