TY - JOUR
T1 - Early telemedical abortion, safeguarding, and under 18s
T2 - a qualitative study with care providers in England and Wales
AU - Romanis, Elizabeth Chloe
AU - Parsons, Jordan
N1 - Acknowledgments: We are grateful to all the healthcare providers who took part in this study, and to our study collaborators for their invaluable assistance. We are particularly indebted to Dr Jonathan Lord and Dr Patricia Lohr, and our research assistant Matimba Swana. We are also thankful to the Institute of Medical Ethics for funding the research and to participants who attended at a workshop we hosted at Durham University to present initial findings in July 2022. We are thankful to two anonymous reviewers for their constructive comments on an earlier draft.
PY - 2023/10/18
Y1 - 2023/10/18
N2 - Background: Telemedical early medical abortion (TEMA) was introduced in England and Wales as a temporary measure in 2020 and was made permanent in 2022. While there are considerable data showing the safety, efficacy, and acceptability of TEMA for patients, there have been objections raised to TEMA based on safeguarding—particularly for people under 18 years of age. Little is known about abortion care providers’ views and experiences of carrying out their safeguarding duties with people aged under 18 in the shift to TEMA.Methods: This is a qualitative study involving online semi-structured interviews and reflexive thematic analysis. Audio-recorded, semi-structured interviews with abortion providers in England and Wales (n=20) generated data about their views and experiences of safeguarding in telemedical abortion care. Recordings were transcribed verbatim and then subject to reflexive thematic analysis to construct themes.Results: While the study was designed with adult safeguarding in mind, the safeguarding of under 18s became a key area of discussion. Three major themes were constructed in relation to under 18s: (1) age as a risk factor in safeguarding; (2) telemedicine as improving access to care; and (3) telemedicine as enhancing communication.Conclusion: Care providers believe TEMA has benefitted the under 18s. There was a strong feeling both that TEMA had improved access (which, in turn, improved safeguarding) and that under 18s were comfortable communicating using remote means. Providers believe safeguarding proformas must account for the different nature of risks where service users are under 18, but that it is disproportionate to assume that TEMA is unsuitable for all under 18s or groups of under 18s.
AB - Background: Telemedical early medical abortion (TEMA) was introduced in England and Wales as a temporary measure in 2020 and was made permanent in 2022. While there are considerable data showing the safety, efficacy, and acceptability of TEMA for patients, there have been objections raised to TEMA based on safeguarding—particularly for people under 18 years of age. Little is known about abortion care providers’ views and experiences of carrying out their safeguarding duties with people aged under 18 in the shift to TEMA.Methods: This is a qualitative study involving online semi-structured interviews and reflexive thematic analysis. Audio-recorded, semi-structured interviews with abortion providers in England and Wales (n=20) generated data about their views and experiences of safeguarding in telemedical abortion care. Recordings were transcribed verbatim and then subject to reflexive thematic analysis to construct themes.Results: While the study was designed with adult safeguarding in mind, the safeguarding of under 18s became a key area of discussion. Three major themes were constructed in relation to under 18s: (1) age as a risk factor in safeguarding; (2) telemedicine as improving access to care; and (3) telemedicine as enhancing communication.Conclusion: Care providers believe TEMA has benefitted the under 18s. There was a strong feeling both that TEMA had improved access (which, in turn, improved safeguarding) and that under 18s were comfortable communicating using remote means. Providers believe safeguarding proformas must account for the different nature of risks where service users are under 18, but that it is disproportionate to assume that TEMA is unsuitable for all under 18s or groups of under 18s.
U2 - 10.1136/bmjsrh-2022-201762
DO - 10.1136/bmjsrh-2022-201762
M3 - Article
VL - 49
SP - 238
EP - 244
JO - BMJ Sexual & Reproductive Health
JF - BMJ Sexual & Reproductive Health
IS - 4
ER -