LBJ School of Public Affairs, The University of Texas at Austin.
Population Research Center, The University of Texas at Austin.
JAMA Netw Open. 2021 May 3;4(5):e2111852. doi: 10.1001/jamanetworkopen.2021.11852.
People in the US have been seeking self-managed abortions outside the formal health care system using medications obtained through online telemedicine. However, little is known about this practice, including potential motivating factors.
To examine individual reasons for accessing medication abortion through an online telemedicine service as well as associations between state- and county-level factors and the rate of requests.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study examined all requests for self-managed medication abortion through an online consultation form available from Aid Access, a telemedicine service in the US, between March 20, 2018, and March 20, 2020.
Individual-level reasons for accessing the telemedicine service were examined as well as the rate of requests per 100 000 women of reproductive age by state. Zip code data provided by individuals making requests were used to examine county-level factors hypothesized to be associated with increased demand for self-managed abortion: distance to a clinic (calculated using location data for US abortion clinics) and the population proportion identifying as a member of a racial/ethnic minority group, living below the federal poverty level, and having broadband internet access (calculated using census data).
During the 2-year study period, 57 506 individuals in 2458 counties in 50 states requested self-managed medication abortion; 52.1% were aged 20 to 29 years (mean [SD] age, 25.9 [6.7] years), 50.0% had children, and 99.9% were 10 weeks' pregnant or less. The most common reasons cited by individuals making requests were the inability to afford in-clinic care (73.5%), privacy (49.3%), and clinic distance (40.4%). States with the highest rate of requests were Louisiana (202.7 per 100 000 women) and Mississippi (199.9 per 100 000 women). At the county level, an increase of 1 SD (47 miles) in distance to the nearest clinic was significantly associated with a 41% increase in requests (incidence rate ratio, 1.41; 95% CI, 1.31-1.51; P < .001), and a 10% increase in the population living below the federal poverty level was significantly associated with a 20% increase in requests (incidence rate ratio, 1.20; 95% CI, 1.13-1.28; P < .001).
In this cross-sectional study, clinic access barriers were the most commonly cited reason for requesting self-managed medication abortion using an online telemedicine service. At the county level, distance to an abortion clinic and living below the federal poverty level were associated with a higher rate of requests. State and federal legislation could address these access barriers.
美国民众一直在通过在线远程医疗获得的药物，在正规医疗体系之外寻求自行管理的堕胎。然而，人们对这种做法知之甚少，包括潜在的推动因素。
通过在线远程医疗服务获取药物堕胎的个体原因，并探讨州和县级因素与请求率之间的关系。
设计、设置和参与者：这项基于人群的横断面研究调查了 2018 年 3 月 20 日至 2020 年 3 月 20 日期间 Aid Access 提供的在线咨询表格中所有要求自行管理药物堕胎的个人。Aid Access 是美国的一家远程医疗服务机构。
检查了使用在线远程医疗服务的个体原因，以及按州计算的每 10 万名育龄妇女的请求率。个人提出请求时提供的邮政编码数据用于检查假设与自行管理堕胎需求增加相关的县级因素：到诊所的距离（通过美国堕胎诊所的位置数据计算）以及认定为种族/少数民族成员的人口比例、生活在联邦贫困线以下以及拥有宽带互联网接入（通过人口普查数据计算）。
在为期 2 年的研究期间，来自 50 个州 2458 个县的 57506 人要求自行管理药物堕胎；52.1%的人年龄在 20 至 29 岁（平均[SD]年龄 25.9[6.7]岁），50.0%有孩子，99.9%怀孕 10 周或更短。个人提出请求的最常见原因是无力支付门诊费用（73.5%）、隐私（49.3%）和诊所距离（40.4%）。请求率最高的州是路易斯安那州（每 10 万名妇女 202.7 例）和密西西比州（每 10 万名妇女 199.9 例）。在县级层面，到最近诊所的距离每增加 1 个标准差（47 英里），请求量就会显著增加 41%（发病率比，1.41；95%CI，1.31-1.51；P < .001），生活在联邦贫困线以下的人口增加 10%，请求量也会显著增加 20%（发病率比，1.20；95%CI，1.13-1.28；P < .001）。
在这项横断面研究中，门诊就诊障碍是最常被引用的使用在线远程医疗服务自行管理药物堕胎的原因。在县级层面，到堕胎诊所的距离和生活在联邦贫困线以下与请求率较高有关。州和联邦立法可以解决这些获取障碍。
