Telemedicine as an alternative way to access abortion in Italy and characteristics of requests during the COVID-19 pandemic.

Introduction: Induced abortion is legal in Italy but with restrictions. The online abortion provider Women on Web (WoW) serves as an alternative way to access abortion. The COVID-19 pandemic has affected sexual and reproductive health worldwide. Italy was one of the first countries hit by the pandemic and imposed strict lockdown measures. We aimed to understand why women requested WoW abortion in Italy and how this was affected by the pandemic.
Methods: We conducted an observational study analysing requests made to WoW before and during the pandemic. We analysed 778 requests for medical abortion from Italy between 1 March 2019 to 30 November 2020 and compared the characteristics of requests submitted before and during the pandemic. We also performed subgroup analysis on teenagers and COVID-19-specific requests.
Results: There was an increase in requests during the COVID-19 pandemic compared with the previous year (12% in the first 9 months). The most common reasons for requesting a telemedicine abortion through WoW were privacy-related (40.9%); however, this shifted to COVID-19-specific (50.3%) reasons during the pandemic. Requests from teenagers (n=61) were more frequently made at later gestational stages (p=0.003), had a higher prevalence of rape (p=0.003) as the cause of unwanted pregnancies, and exhibited less access to healthcare services compared with adult women.
Conclusions: There was an increase in total demand for self-managed abortion during the pandemic and reasons for requesting an abortion changed, shifting from privacy-related to COVID-19-specific reasons. This study also highlighted the uniquely vulnerable situation of teenagers with unwanted pregnancies seeking self-managed abortion.
Competing Interests: Competing interests: HV has received grants/contracts from Fulbright Sweden and University of Washington. MP has received support for attending meetings/travelling from ExcelGyn and is on the International Advisory Board for ExcelGyn. KG-D has received consulting fess from Bayer, MSD, Gedeon Richter, Mithra, Exeltis, MedinCell, Cirqle, Natural Cycles, Exelgyn, Campus Pharma and HRA-Pharma. KG-D has received payments or honoraria for lectures etc. from Bayer, MSD, Gedeon Richter, Mithra, Exeltis, Exelgyn and Campus Pharma. KG-D participates in advisory boards/data and safety monitoring boards (DSMB) for Gedeon Richter and Bayer. KG-D has unpaid board memberships and similar for the International Federation of Gynecology and Obstetrics (FIGO), the World Health Organization (WHO) Department of Sexual and Reproductive Health and Research (SRH) and Human Reproduction Programme (HRP), the European Society of Contraception and Reproductive Health (ESC), the International Federation for Professionals in Abortion and Contraception (FIAPAC) and the Faculty of Sexual & Reproductive Healthcare (FSRH)/Royal College of Obstetricians & Gynaecologists in the UK. RG is the founder of Women on Web (WoW).
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