Psychosocial burden when accessing medication abortion when using no-test telehealth care compared to in-person care with ultrasound.

Abstract

Objective: To explore whether model of abortion care and living in a state with an abortion ban are associated with the psychosocial burden of care-seeking.

Methods: From May 2021-March 2023, we surveyed patients obtaining medication abortion < 70 days gestation, ages > 15 years at four abortion clinic organizations in six U.S. states. We used negative binomial regression to assess three psychosocial burden dimensions: structural challenges (5 items, α=.80); lack of autonomy (3 items, α=.73); and others' reactions to the pregnancy (2 items, α=.88) by abortion care model (no-test telehealth + mail, no-test + pickup, and in-person + ultrasound) and living in a state with an abortion ban.

Results: Of the 486 people who initiated a survey, 400 completed psychosocial burden items. In adjusted analyses, no-test telehealth + mail was associated with less overall psychosocial burden [incident rate ratio (IRR) 0.82, 95% Confidence Interval (CI) 0.70,0.95], including fewer structural challenges (IRR 0.78, 95% CI 0.67,0.91) and less lack of autonomy (IRR 0.65, 95% CI 0.47,0.90) than in-person care with ultrasound, mostly due to less difficulty traveling for abortion care (24% vs 32%, p<.05) and feeling less forced to wait after making the decision (11% vs 22%, p<.05). People in states with bans reported more psychosocial burden (IRR 1.62, 95% CI 1.26,2.08) including more structural challenges (IRR 1.95 0.36, 95% CI 1.53,2.29) than people in states without bans.

Conclusion: No-test telehealth abortion care may reduce the psychosocial burden of care-seeking, especially the difficulties of travel and feeling forced to wait for care.

Implications: Findings add to the body of evidence in support of expanding telehealth abortion care by reducing travel burden and potentially increasing autonomous decision-making when seeking abortion care.