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

Objectives: To explore the relationship between abortion care model and living in a state with an abortion ban with the psychosocial burden of care-seeking.

Study design: From May 2021 to 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 = 0.80), lack of autonomy (3 items, α = 0.73), and others' reactions to the pregnancy (2 items, α = 0.88) by abortion care model (no-test telehealth + mail, no-test + pickup, and in-person + ultrasound) and living in an abortion-ban state.

Results: 400 people 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 + ultrasound, mostly due to less difficulty traveling (24% vs 32%, p < 0.05) and feeling less forced to wait after deciding (11% vs 22%, p < 0.05). People in abortion-ban states 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.

Conclusions: 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.