INDIA – The case for the use of telehealth for abortion

by Sruthi Chandrasekaran, VS Chandrashekar, Suchitra Dalvie, Anand Sinha

Sexual and Reproductive Health Matters 2021;29(2), 2 June 2021 (Open access)

India has the world’s fastest growing outbreak of Covid-19. With limited mobility, increased reports of intimate partner violence, changes in living patterns of migrants, delays in accessing contraception and safe abortion care, and potential changes to decisions about parenting, there may be an increased need for abortion services in India due to the pandemic. The use of technology for providing abortion information and services has been well documented in global literature. The safety of abortion provision using telehealth has been established in several contexts including the United States and Australia. The importance of hotlines and other support systems that use technology to provide information and support to clients through their abortion is also highlighted in the literature. Several countries, such as the United Kingdom, France, New Zealand, and Pakistan are now allowing the use of technology for abortion/post-abortion care in light of the pandemic; however, India’s telemedicine guidelines do not include abortion. In a country where the majority of abortions take place outside the health system, allowing the use of telemedicine for abortion can help bring legality to users, and expand access to those facing additional barriers in accessing the care they deserve. We outline models for telemedicine provision of abortion in India and discuss the regulatory changes required to make telehealth for abortion a reality in India.

Excerpts from main text
Several models for various components of telemedicine abortion provision exist in practice. In a site-to-site model, the client receives care at a clinic and the provider is located in a remote location. Another clinical staff member who does not provide abortion care may be present in the clinic to facilitate the client’s visit. In the direct-to-client model, the client is at home (or another convenient location) when receiving care. Telehealth technologies that have been used in these models include videoconferencing, telephone calls, and text and internet-based messaging. Below, we outline some examples of telehealth models for abortion provision – specifically counselling, eligibility assessment, medication acquisition, and support….

Since the beginning of the pandemic, several technological platforms have seen a rise in the number of unique users and consultations across different fields of health. Telemedicine is already being used for non-urgent gynaecological and obstetric consultations, thereby providing appropriate care and counselling and reducing in-person consultations and follow-up appointments during the pandemic….

Based on existing models of care, a system of remote care could look like the following: Abortion seekers could speak with a registered medical provider (RMP) who could assess eligibility for medical abortion. The RMP could be located physically in a clinic or taking the call virtually through the internet or phone. The eligibility assessment could include pregnancy confirmation (a positive urine pregnancy test or an assessment of pregnancy signs and symptoms) and dating (relatively certain estimate of the first day of their last menstrual period), as well as assessing for risk factors for ectopic pregnancy.26,27 For those deemed eligible for medical abortion, prescriptions can be provided as outlined in the Telemedicine Practice Guidelines. Clients can then procure the medications from a nearby local pharmacy or e-pharmacy….

If a list of RMPs willing to provide remote care can be collated, abortion seekers could reach out to hotlines and online platforms to find their nearest provider. Hotlines and online platforms could counsel abortion seekers and assist them with finding an RMP who is able to provide remote support. Hotlines and online sources could also provide further information on what to expect during the process, how to manage side effects, symptoms, and signs of possible complications, provide support during the abortion process, and carry out follow-up assessments. If clients require additional clinical support, they could help direct them to the nearest facility for care. Thus, various models of telehealth could work hand-in-hand to support abortion clients in a manner similar to that for other healthcare services….

Evidence from literature in India suggests nurses, allopathic and ayurvedic physicians are all able to effectively assess medical eligibility and assess completion of abortion. Hence, the Medical Termination of Pregnancy Act needs to be amended to include the cadre of health workers who can provide abortions, which could dramatically increase access to safe abortion, especially in rural areas. In addition, there is over-regulation of medical abortion pills by drug control authorities, which is resulting in the non-availability of abortion pills in many states.

VISUAL: Getty Images in, 19 May 2020