Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis

Abstract

The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-sectional multilevel study to assess the effect of individual and contextual social factors on utilization of one such service. For the individual-level, we analyzed data from the records of abortion seekers contacting this feminist international telehealth organization during 2019 (n = 25,920). Individual-level variables were age, race, education level and pregnancy length. Contextual-level units were states, for which we used data from the national Demographic Census and Household Surveys. Contextual-level variables were household income per capita, adjusted net school attendance rate, percentage of racialized women and income Gini Index. We fitted five multilevel Poisson Mixed-effects models with robust variance to estimate prevalence ratios (PR) of service utilization, which was defined as receiving abortion pills through the service. We found that only 8.2% of requesters got abortion pills through the service. Utilization was higher among women who were older, white, more educated and 5–8-weeks pregnant. Independently of this, service utilization was higher in states with higher income and education access, with lower proportions of racialized women, and located in the South, Southeast and Central-West regions. We concluded that while feminist telehealth abortion initiatives provide a life-saving service for some abortion seekers, they are not fully equipped to overcome entrenched social inequalities in their utilization, both at individual and contextual levels.

Medication abortion via digital health in the United States: a systematic scoping review

“…Care providers felt that telemedicine increased access to medication abortion, facilitated a more user-centered approach, and reduced long-distance traveling time by both patients and physicians. Although telemedicine is believed to make abortion services more accessible, the study conducted in Brazil revealed inequalities in the utilization of abortion services via telemedicine across various regions, which varied based on income, and among different racial groups 47 . Given that provision of services via telemedicine requires access to advanced technologies such as high internet speed, populations who lack reliable internet access or who lack knowledge and education about the use of these technologies could be disproportionally affected by limited ability to utilize the service.…”