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Introduction Use of telemedicine in abortion care is safe and effective. Patient satisfaction with telemedically supported abortion is high, but as use expands in Britain, little is known about patients’ or health professionals’ views on how it is best used. We sought the views of both groups on telemedicine's role in abortion provision and how its use might be optimised. Methods We administered a structured survey with an additional free-text response option to a range of health professionals from services identified via clustered random sampling. We conducted semi-structured interviews with patients with recent experience of abortion, purposively sampled from abortion services. Participants were recruited from England, Scotland and Wales. We analysed qualitative data using thematic analysis alongside framework analysis. Results Support for telemedicine was high among participants, which included 771 health professionals from a range of services and 48 patients. Among health professionals, 23% opposed the use of telemedicine in abortion provision. Opposition was highest among those uninvolved, or who did not feel skilled, in remote provision. Reported benefits included patient convenience and comfort. Patient concerns centred on adequate provision of emotional support. Participants made suggestions for augmenting and extending the use of telemedicine to meet some patients’ needs, including combining telemedical consultation with in-person care and providing information and follow-up via digital methods. Conclusions Acceptability of telemedically supported abortion, which offers logistical and emotional benefits to patients, is high in Britain. Novel ways of providing telemedical support should be explored to enhance remote abortion provision. In-person care should remain an option for patients.

Background: Models of abortion care have changed significantly in the last decade, most markedly during the COVID-19 pandemic, when home management of early medical abortion with telemedical support was approved in Britain. Objective: Our study aimed to examine women’s satisfaction with abortion care and their suggestions for improvements. Design: Qualitative, in-depth, semi-structured interviews. Methods: A purposive sample of 48 women with recent experience of abortion was recruited between July 2021 and August 2022 from independent sector and National Health Service abortion services in Scotland, Wales and England. Interviews were conducted by phone or via video call. Women were asked about their abortion experience and for suggestions for any improvements that could be made along their patient journey – from help-seeking, the initial consultation, referral, treatment, to aftercare. Data were analyzed using the Framework Method. Results: Participants were aged 16–43 years; 39 had had a medical abortion, 8 a surgical abortion, and 1 both. The majority were satisfied with their clinical care. The supportive, kind and non-judgmental attitudes of abortion providers were highly valued, as was the convenience afforded by remotely supported home management of medical abortion. Suggestions for improvement across the patient journey centred around the need for timely care; greater correspondence between expectations and reality; the importance of choice; and the need for greater personal and emotional support. Conclusion: Recent changes in models of care present both opportunities and challenges for quality of care. The perspectives of patients highlight further opportunities for improving care and support. The principles of timely care, choice, management of expectations, and emotional support should inform further service configuration.

Plain English summary Quality of care is an important aspect of delivering healthcare in a patient-centred manner. There is a lack of agreement about what consititutes quality care for an abortion service. In our study, we interviewed 24 participants who had an abortion in the last 6 months to assess their perceptions of quality of care. Based on our analysis, we identified 4 themes that were important contributors to quality: (1) interactions with clinic staff or other patients, (2) information and preparation for the abortion, (3) making choices about care, and (4) access to abortion care. Almost all of our study participants said that positive interactions with clinic staff contributed to a quality experience. Participants wanted to be well-prepared for their abortion. They reported a negative experience when the information they were given did not match their experience. Participants felt that active participation in choices around their abortion experience improved quality. Finally, ease of access to abortion care made for a more positive experience. Abortion providers and researchers should consider using the results of our study to ensure their services meet patients’ needs.

Abstract Background One in three women in the United Kingdom (UK) will have an abortion before age 45, making abortion provision an essential aspect of reproductive healthcare. Despite this, abortion remains ethically contested and stigmatised, with variable teaching in UK medical schools and concerns about falling numbers of doctors willing to participate in abortion care. University College London Medical School (UCLMS) has designed practical, inclusive, teaching that aims to give students an understanding of the importance of abortion care and prepare them to be competent practitioners in this area. This study aimed to determine students’ opinions of this teaching and their wider attitudes towards abortion. Methods We invited all 357 final-year UCL medical students to complete an online survey consisting of closed-ended questions, exploring their opinions on their abortion teaching, their personal beliefs about abortion and their future willingness to be involved in abortion care. We analysed responses using non-parametric tests. Results One hundred and forty-six questionnaires (41% response rate) showed 83% of students identified as pro-choice (agree with the right to choose an abortion). Fifty-seven percent felt they received the right amount of abortion teaching, 39% would have liked more and 4% stated they received too much. There was no correlation between students’ attitudes to abortion and the rating of teaching; both pro-choice and pro-life (opposed to the right to choose an abortion) students generally rated the teaching as important and valued the range of methods used. Students requested more simulated practice speaking to patients requesting an abortion. Students with pro-life beliefs expressed lower willingness to discuss, refer, certify and provide future abortions. Students interested in careers in specialties where they may encounter abortion were more likely to be pro-choice than pro-life. Conclusions The majority of participating UCL medical students were pro-choice and willing to be involved in future abortion care. Efforts to make teaching on abortion practical, engaging, sensitive and inclusive were appreciated. As well as preparing students to be competent and caring practitioners, the teaching appears to contribute towards them viewing abortion as an essential aspect of women’s healthcare, and may contribute to destigmatising abortion.

Resumen Propósito A pesar de que Gran Bretaña, Colombia y algunos estados mexicanos comparten una causal salud dentro de sus leyes de aborto, el acceso al aborto bajo la causal varía ampliamente. Este estudio examina los factores que resultan en la aplicación heterogénea de leyes similares y las consecuencias para el acceso al aborto legal. Nuestra investigación se suma a la literatura anterior comparando la implementación de leyes entre países para dilucidar estrategias para la implementación total. Métodos Realizamos un estudio descriptivo comparativo entre países que sintetizó datos de la revisión de documentos, estadísticas oficiales, y entrevistas con informantes claves. Recopilamos información sobre el uso y la interpretación de la causal salud en los tres países haciendo referencia a literatura revisada por pares, documentos judiciales, y literatura gris. Extraemos estadísticas públicos y privados para comprender la aplicación de la ley en cada entorno. Usamos una matriz para sintetizar información e identificar factores clave en el uso de la causal salud. Realizamos entrevistas en profundidad con médicos y expertos familiarizados con las leyes y analizamos los datos cualitativos en función de los factores previamente identificados. Resultados La causal salud se usa ampliamente en Gran Bretaña, a veces en Colombia, y casi nunca en los estados mexicanos. Identificamos cinco factores relevantes para la aplicación de la causal salud: 1) la exhaustividad de la ley, incluyendo la mención explícita de la salud mental, 2) un fuerte sector de salud pública que financia el aborto, 3) conocimiento y actitudes hacia la ley, incluyendo directrices para los médicos, 4) difusión de información sobre la causal salud, y 5) un historial de casos judiciales que protegen a las mujeres y clarifican la ley. Conclusiones La causal salud es una herramienta valiosa para ampliar el acceso al aborto legal. Las diferencias en el uso de la causal dan como resultado un amplio acceso para mujeres en Gran Bretaña a casi ningún acceso en los estados mexicanos. Nuestros hallazgos resaltan la diferencia entre el acceso teórico y real al aborto legal. La interpretación y la aplicación de la causal salud son cruciales para expandir el acceso real al aborto.