Telemedicine abortion: A channel to Brazilian women

Diniz, Débora; Ambrogi, Ilana; Carino, Giselle

doi:10.1002/ijgo.13821

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…Abortion care, which is considered an elective procedure even in cases in which the procedure is legal, was relegated to the background in order to prioritize measures to combat Covid-19 [57]. Therefore, it has become even more urgent to review the current protocols of abortion care under these circumstances, including the implementation of new technologies such as telemedicine, which is known to be effective and safe [58][59][60]. All these changes would encourage respect for women's health and life by offering humanized treatment of abortion.…”

Section: Discussionmentioning

confidence: 99%

Delays in obtaining hospital care and abortion-related complications within a context of illegality

Hamui,

Aquino,

Menezes

et al. 2023

PLoS ONE

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Abortion, particularly when illegal, highlights inequities in different populations. Although abortion-related mortality is lower compared to other obstetric causes, abortion complications tend to be more lethal. Delays in seeking and obtaining care are determinants of negative outcomes. This study, nested within the GravSus-NE, analyzed healthcare delays and their association with abortion-related complications in three cities of northeastern Brazil (Salvador, Recife and São Luís). Nineteen public maternity hospitals were involved. All eligible women ≥18 years old hospitalized between August and December 2010 were evaluated. Descriptive, stratified and multivariate analyses were performed. Youden’s index was used to determine delay. One model was created with all the women and another with those admitted in good clinical conditions, thus determining complications that occurred during hospitalization and their associated factors. Of 2,371 women, most (62.3%) were ≤30 years old (median 27 years) and 89.6% reported being black or brown-skinned. Most (90.5%) were admitted in good condition, 4.0% in fair condition and 5.5% in poor/very poor condition. Median time between admission and uterine evacuation was 7.9 hours. After a cut-off time of 10 hours, the development of complications increased considerably. Black women and those admitted during nightshifts were more likely to experience a wait time ≥10 hours. Delays were associated with severe complications (OR 1.97; 95%CI: 1.55–2.51), including in the women admitted in good condition (OR 2,56; 95%CI: 1.85–3.55), and even following adjustment for gestational age and reported abortion type (spontaneous/induced). These findings corroborate the literature, highlighting the social vulnerability of women hospitalized within Brazil’s public healthcare system in a situation of abortion. The study strongpoints include having objectively measured the time between admission and uterine evacuation and having established a cut-off time defining delay based on conceptual and epidemiological criteria. Further studies should evaluate other settings and new measurement tools for effectively preventing life-threatening complications.

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Section: Discussionmentioning

confidence: 99%

Delays in obtaining hospital care and abortion-related complications within a context of illegality

Hamui,

Aquino,

Menezes

et al. 2023

PLoS ONE

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“…It can also overlook the problematic attitudes of clinic providers (Halfmann 2012) and decenter the importance of creating atmospheres of trust and dialogue between caregivers and the cared-for (Fisher and Tronto 1990). While the expansion of self-managed abortion, driven by activists in Brazil (Bloomer, Pierson, and Estrada-Claudio 2018;Baum et al 2020;Diniz, Ambrogi, and Carino 2021), has led to the expansion of telemedicine and abortion "at home" in the minority world, an expansion that escalated rapidly during the COVID-19 pandemic (Lohr 2022), medical models have not been displaced. "At home" abortion care, "community models," and telemedicine in countries such as the United Kingdom, the United States, and Australia remain clinician-led, underscored by concerns of risk and safety.…”

Section: Developing Abortion Care Through Acompañante Care Workmentioning

confidence: 99%

Beyond the State: Abortion Care Activism in Peru

Duffy¹,

Freeman²,

Castañeda³

2023

Signs: Journal of Women in Culture and Society

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“…Additionally, little is known about the relationship between structural inequalities and utilization of initiatives that use the Internet to increase access to safe abortion. During the last few years, and particularly with the advent of COVID-19, Internet-based abortion provision has been continuously growing both in Brazil and around the world ( 28 , 29 ). With this study, we aim to contribute to the understanding of inequalities in abortion access in Brazil by assessing how individual and contextual social factors impact utilization of an online feminist service supporting self-managed abortion.…”

Section: Introductionmentioning

confidence: 99%

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

Larrea

Palència

Assis

et al. 2022

Front. Reprod. Health

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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.

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Telemedicine abortion: A channel to Brazilian women

Abstract: Synopsis In Brazil, telemedicine abortion is an urgently needed change which can guarantee access to essential care for vulnerable women and girls during public health emergencies.

Cited by 3 publications

References 3 publications

Delays in obtaining hospital care and abortion-related complications within a context of illegality

Delays in obtaining hospital care and abortion-related complications within a context of illegality

Beyond the State: Abortion Care Activism in Peru

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

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