Authors: Ernest Afriyie Owusu, Matthea Roemer, Ernestina Monney, Prince Dugbazah, Ellis Nutifafa Attah, George Akanlu, Chris Fofie
BMJ Global Health, 4 May 2026. Open access.
Abstract
Background: In 2021, Ghana’s National Comprehensive Abortion Care Standards and Protocols recognised telemedicine as an approved delivery model for early medical abortion (EMA). Following a successful pilot in Accra, MSI Reproductive Choices Ghana expanded their telemedicine model to more rural areas and broadened their package of sexual and reproductive health (SRH) services to include fertility evaluation. This study evaluates the expanded model.
Methods: A mixed-methods evaluation (January 2024 to March 2025) drew on routine clinical data, courier and call centre tracking, client feedback surveys, and qualitative, individual in-depth interviews with telemedicine clients to assess clinical safety, service utilisation and user experience. Quantitative analysis included descriptive statistics and unadjusted logistic and ordinal regression. Qualitative interviews with clients explored feasibility, acceptability and implementation challenges. A deductive, thematic analysis was conducted with the support of Delve qualitative research software and guided by the Consolidated Framework for Implementation Research.
Results : A total of 2721 clients accessed telemedicine services, with 70.0% receiving EMA and 29.5% short-term contraceptive methods. Among EMA clients reached for follow-up, 96.9% reported complete abortion with no further intervention. Satisfaction was high: 89.4% would recommend the service, and 78.2% would use it again. Qualitative findings highlighted that clients valued privacy, convenience and autonomy, particularly in stigmatised or crowded spaces. Barriers to accessing services included unclear eligibility criteria, limited digital access and misperceptions that the service was for abortion only. Most clients contacted the service between 4 and 6 weeks’ gestation. Post-abortion contraception uptake was 24.8%, with no significant variation by age or location. Nearly half of clients reported having no other way to access care.
Conclusions: Telemedicine is a feasible, safe and acceptable model for SRH delivery in Ghana. Findings will inform national scale-up and strategies to strengthen equity, communication and service integration.
Figure 1. Telemedicine uptake by location and service type
Left: EMA, early medication abortion: Telemedicine uptake by location and service type, 2024.
Right: STM, short-term contraceptive method uptake, 2024.
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What is already known on this topic
- Telemedicine is a well-recognised option for early medical abortion (EMA) both globally and in Ghana and has shown promise in urban pilot settings as a safe and acceptable alternative to in-person care. However, evidence on its feasibility, safety and user experience in more rural and resource-constrained settings—and for a broader range of sexual and reproductive health (SRH) services—remains limited.
What this study adds
- This mixed-methods evaluation demonstrates that a scaled telemedicine model for SRH, including EMA and short-term contraception, is feasible, safe and highly acceptable when expanded to more rural regions of Ghana. Clients valued the model’s privacy, convenience and support for self-managed care, though barriers around digital access, service visibility and continuity of care remain.
How this study might affect research, practice or policy
- Findings support the national scale-up of telemedicine for sexual and reproductive health and rights (SRHR) in Ghana and provide practical insights for improving access, equity and service integration. This study also contributes to the global evidence base on designing client-centred telehealth models that extend beyond abortion to comprehensive SRH services in low-income and middle-income settings.