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Introduction Since 2011, Planned Parenthood of the Great Northwest and the Hawaiian Islands has been providing medical abortion via telemedicine at several clinics in Alaska. The purpose of this study was to evaluate providers' experiences with telemedicine provision of medical abortion in Alaska using qualitative methods. In particular, we aimed to learn more about the impacts of telemedicine on patients, staff, and clinic operations and potential lessons for other service delivery settings. Methods Between October and November 2013, eight in-depth interviews were conducted with clinic providers and staff who were involved with the provision of medical abortion using telemedicine at Planned Parenthood of the Great Northwest and the Hawaiian Islands clinics in Alaska. All interviews were digitally recorded and transcribed verbatim, and data were analysed qualitatively with inductive coding using grounded theory methods. Results Providers reported that telemedicine provision of medical abortion facilitated a more patient-centred approach to care where women were able to be seen sooner, have greater choice in abortion procedure type, and could be seen closer to their home. Providers felt that it was easy to integrate the new technology into clinic operations, and that a telemedicine visit largely required the same overall processes and clinic flow as an in-person visit, with minor additions related to technological set-up for the doctor interface. Discussion These findings are consistent with previously published literature on medical abortion provided via telemedicine, and indicate high acceptability among providers and the appropriateness for telemedicine application to this healthcare service. [ABSTRACT FROM AUTHOR]

Objective: The objective was to investigate public funding policies for abortion in countries with liberal or liberally interpreted laws (defined as permitting abortion for economic or social reasons or upon request).Study Design: In May 2011-February 2012 and June 2013-December 2014, we researched online resources and conducted an email-based survey among reproductive health experts to determine countries' public funding policies for abortion. We categorized countries as follows: full funding for abortion (provided for free at government facilities, covered under state-funded health insurance); partial funding (partially covered by the government, covered for certain populations based on income or nonincome criteria, or less expensive in public facilities); funding for exceptional cases (rape/incest/fetal impairment, health/life of the woman or other limited cases) and no public funding.Results: We obtained data for all 80 countries meeting inclusion criteria. Among the world's female population aged 15-49 in countries with liberal/liberally interpreted abortion laws, 46% lived in countries with full funding for abortion (34 countries), 41% lived in countries with partial funding (25 countries), and 13% lived in countries with no funding or funding for exceptional cases only (21 countries). Thirty-one of 40 high-income countries provided full funding for abortion (n=20) or partial funding (n=11); 28 of 40 low- to middle-income countries provided full (n=14) or partial funding for abortion (n=14). Of those countries that did not provide public funding for abortion, most provided full coverage of maternity care.Conclusion: Nearly half of countries with liberal/liberally interpreted abortion laws had public funding for abortion, including most countries that liberalized their abortion law in the past 20 years. Outliers remain, however, including among developed countries where access to abortion may be limited due to affordability.Implications: Since cost of services affects access, country policies regarding public funding for services should be monitored, and advocacy should prioritize ensuring the affordability of care for low-income women. [ABSTRACT FROM AUTHOR]

Objectives. We assessed the effect of a telemedicine model providing medical abortion on service delivery in a clinic system in Iowa. Methods. We reviewed Iowa vital statistic data and billing data from the clinic system for all abortion encounters during the 2 years prior to and after the introduction of telemedicine in June 2008 (n = 17 956 encounters). We calculated the distance from the patient's residential zip code to the clinic and to the closest clinic providing surgical abortion. Results. The abortion rate decreased in Iowa after telemedicine introduction, and the proportion of abortions in the clinics that were medical increased from 46% to 54%. After telemedicine was introduced, and with adjustment for other factors, clinic patients had increased odds of obtaining both medical abortion and abortion before 13 weeks' gestation. Although distance traveled to the clinic decreased only slightly, women living farther than 50 miles from the nearest clinic offering surgical abortion were more likely to obtain an abortion after telemedicine introduction. Conclusions. Telemedicine could improve access to medical abortion, especially for women living in remote areas, and reduce second-trimester abortion. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: U.S. military women and dependents have few options for abortion when facing an unintended pregnancy overseas. Federal law prohibits the use of Department of Defense facilities and funds for abortion except when the woman’s life is at risk, and privately funded abortions are permitted at military facilities only if a pregnancy is the result of rape or incest. The purpose of this study was to explore military women’s experiences seeking abortion care during overseas deployment. Methods: We reviewed routine consultation data and user queries from an online service providing information about medication abortion. Information received between September 2005 and December 2009 from U.S. military women and dependents overseas was included. All women gave consent for anonymous use of their data, which were analyzed qualitatively for themes related to experiences seeking abortion. Findings: Data were analyzed for 130 women, including 128 women in the U.S. military and 2 military dependents. Women reported facing numerous challenges accessing abortion overseas, including legal and logistical barriers to care in-country, and real or perceived difficulties accessing abortion elsewhere owing to confidentiality concerns, fear of military reprimand for the pregnancy, and the narrow timeframe for early abortion. With no perceived alternatives, some women considered unsafe methods to terminate the pregnancy themselves. Conclusion: U.S. servicewomen overseas lack access to safe abortion services, which may place their health and careers in jeopardy. These women should have the same rights to abortion care as women living in the United States. [Copyright &y& Elsevier]

Abstract: Background: In states requiring physicians to dispense mifepristone, the small number of providers offering the method limits its uptake. In 2008, Planned Parenthood of the Heartland in Iowa began providing medical abortion via telemedicine at clinics without an on-site physician. The purpose of this study was to evaluate patients'' and providers'' experiences with telemedicine provision of medical abortion. Methods: Between October 2009 and February 2010, in-depth interviews were conducted at Planned Parenthood clinics with 25 women receiving medical abortion services (20 telemedicine patients and 5 in-person patients) and 15 clinic staff. Data were analyzed qualitatively for themes related to acceptability of the telemedicine service delivery model. Findings: Patients and providers cited numerous advantages of telemedicine, including decreased travel for patients and physicians and greater availability of locations and appointment times compared with in-person provision. Overall, patients were positive or indifferent about having the conversation with the doctor take place via telemedicine, with most reporting it felt private/secure and in some cases even more comfortable than an in-person visit. However, other women preferred being in the same room with the physician, highlighting the importance of informing women about their options so they can choose their preferred service modality. Conclusions: The findings from this study indicate that telemedicine can be used to provide medical abortion in a manner that is highly acceptable to patients and providers with minimal impact on the clinic. Practice Implications: This information demonstrates the feasibility of telemedicine to extend the reach of physicians and improve abortion access in rural settings. [Copyright &y& Elsevier]

U.S. servicewomen have high rates of unintended pregnancy, but federal policy prohibits abortion provision at military treatment facilities and military insurance coverage of abortion, except in cases of rape, incest, or a life-endangering pregnancy. Such restrictions pose challenges to abortion access for servicemembers, particularly during deployment. We aimed to explore the experiences of U.S. servicewomen when accessing abortion during overseas tours and deployment. We reviewed de-identified data from email inquiries and online consultation forms from U.S. servicewomen or military spouses seeking medication abortion from the telemedicine service Women on Web between January 2010 and December 2017. We used descriptive statistics and inductively coded textual responses to describe client characteristics, circumstances of pregnancy, reasons for abortion, and barriers to abortion care. Our sample included data for 323 individuals. Reasons for abortion related to military service included disruption of deployment, fear of military reprimand, and potential career impacts. Additionally, servicemembers faced barriers to abortion access related to overseas military deployment or tour, including a lack of legal abortion in-country, limited financial resources, language barriers, travel restrictions, and a lack of confidentiality. U.S. military servicewomen stationed in countries where safe, legal abortion is restricted or unavailable face deployment-related barriers to abortion care, which compound those barriers they may face regardless of deployment status. Removal of federal bans on the provision and coverage of abortion care and improved education about existing regulations could improve access to timely abortion care and in some cases allow servicewomen who wish to obtain abortion care to remain deployed. [ABSTRACT FROM AUTHOR]

Introduction: More U.S. servicewomen than civilian women experience unintended pregnancies, which can impact their health, well-being, and careers. Despite this, federal policy limits abortion access and coverage for military personnel to cases of rape, incest, and life endangerment. This study aimed to document servicewomen's experiences with unintended pregnancy and abortion during deployment, and their knowledge and opinions of military policies related to sexual activity, pregnancy, and abortion.Material and Methods: Between June 2016 and July 2017, we conducted a cross-sectional online survey among a convenience sample of current and former U.S. Military, National Guard, and Reserves members whose last deployment ended in 2010 or later. We asked open- and closed-ended questions about demographics, experiences with pregnancy and abortion during deployment, and knowledge and opinions of military policies related to sexual activity, pregnancy, and abortion. We ran descriptive statistics on closed-ended questions and inductively coded open-ended question responses. This study was approved by the Allendale Investigational Review Board.Results: A total of 319 participants were included. The majority said that servicewomen are reprimanded for sexual activity and becoming pregnant during deployment in all or some circumstances. Among these respondents, one-third said that fear of reprimand for sexual activity affects deployed servicewomen's use of contraception. Twenty respondents became pregnant or discovered that they were pregnant during deployment; twelve were unable to access the pregnancy- and/or abortion-related services they wanted or needed. Among those whose last deployment ended in 2013 or later (n = 141), when federal policy expanded abortion coverage for servicemembers to include cases of rape and incest, the minority knew the correct coverage or provision policies for abortion in cases of rape and incest or life endangerment. The majority believed that the military should cover and provide abortion in cases of rape, incest, or life endangerment and for unwanted pregnancies.Conclusion: Among this convenience sample of current and former servicewomen with an overseas deployment that ended in 2010 or later, 6% became pregnant or discovered that they were pregnant during deployment, and most of these respondents reported being unable to access the pregnancy- and/or abortion-related services they wanted or needed. The majority reported lack of knowledge of military abortion policies and that servicewomen are reprimanded for pregnancy and/or sexual activity in some or all circumstances, with many noting this reprimand as a barrier to contraceptive use for some servicewomen. Predeployment health visits may be one intervention point for disseminating the military's abortion policies; commanding officers should also be well versed in these policies so that they are able to provide effective leadership to junior military members. [ABSTRACT FROM AUTHOR]