Telemedicine abortion in France: Drivers during and beyond the COVID-19 pandemic

By Hazal Atay

The COVID-19 outbreak has posed significant challenges for the provision of abortion care. In the context of the pandemic, national abortion guidelines in France have changed several times. In April 2020, France allowed at-home medical abortion via teleconsultation until 7 weeks of pregnancy (9 weeks of amenorrhea). This measure was adopted in the midst of a national lockdown, which started on 17 March 2020 and continued until 11 May 2020. It was then abandoned in July, only to be adopted once again in November, as the health crisis re-intensified. The use of telemedicine for abortion is now extended until September 2021. In our article, we made a spot-on analysis of this recent measure and examined the drivers of telemedicine abortion in France through a dataset obtained from Women on Web (WoW), a Canadian online telemedicine abortion service.

We conducted a parallel convergent mixed-method study based on 809 consultations done in France between 1 January and 31 December 2020. We found that, while the lockdown measures increased the demand for telemedicine abortion in France, the drivers of telemedicine are manifold and go beyond conditions unique to the pandemic. The preferences and needs regarding secrecy (46.2%), privacy (38.3 %), and comfort (34.9%), followed by the coronavirus pandemic (30.6%), were among the most frequent reasons for women to choose telemedicine abortion in France.

We observed that individuals continue to encounter macro-level, individual-level or provider-level constraints in accessing safe abortion care in France. We noted that, compared to women over 36 years old, younger women who are 18-25 years old are two times more likely to find at-home abortion via telemedicine empowering and three times more likely to prefer having someone with them during the procedure compared to women 36 years old and above. They are, however, also two times more likely to perceive abortion stigma and 53.5% more likely to feel a need to keep their abortion secret from their family or partner. Finally, younger people are also two times more likely to encounter financial difficulties while accessing abortion care in France.

Our research findings suggest that telemedicine can help meet women’s needs and preferences for secrecy, privacy and comfort, while facilitating increased access to and enabling a more person-centred abortion care. Given the inequality of access, along with the macro, individual and provider-level challenges individuals face to access abortion care, our study suggests that telemedicine can help expand access to abortion in places where it remains limited and to those who are most vulnerable. Extending telemedicine abortion care beyond the pandemic and embracing a hybrid model that offers both in-clinic and telemedicine abortion can help meet women’s preferences and needs better, improving both access to abortion and the quality of safe abortion care in France.

 

Read more: Why women choose at-home abortion via teleconsultation in France: drivers of telemedicine abortion during and beyond the COVID-19 pandemic

Hazal Atay is a PhD candidate in political science at Sciences Po Paris, France. Currently, she works as a research assistant on the “Telemedicine abortion in France” project, hosted at the Laboratory for Interdisciplinary Evaluation of Public Policy (LIEPP) in Sciences Po Paris. She mainly works on public policy formation on women’s rights, with a particular focus on sexual and reproductive health and rights.

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