Interpretation
As illustrated in Table 1, all of the UN main geographic regions were represented, with a highly variable frequency of countries. When WoW was launched in 2006, it was available in Polish, English, Spanish, French and Portuguese, whereas today it is available in 24 languages(8, 18). The age distribution for the total sample is as expected and in line with previous reports, showing the peak for having an abortion is often around 20-24, but also common in the early thirties in many countries(24).
The proportion of the total sample reporting that they knew about medical abortion before using the service was 59.2% and remained almost unchanged between 2009 to 2019. Given the advancements over the past years use and acceptability among health care providers, the WHO and NGOs of WoW services, these results suggest that many women only learn about medical abortion once they have an unwanted pregnancy, which has also been suggested previously(25).
Our findings in regards to physical outcomes are in line with previous literature. A recent systematic review of outcomes of medical abortion through telemedicine reported a range of 0-1.9% for continuing pregnancy, 93.8-96.4% for complete abortion, 0.9-19.3% for surgical intervention and 0-0.7% for blood transfusion(11). These results are well in line with our findings except for a slightly lower rate of complete abortion of 87.9%. This is still in line with rates reported in studies on in-clinic medical abortion treatment(16). The higher rate in surgical interventions compared with other studies might be explained by the fact that the number of women living in Poland accounted for almost half of the total sample and the surgical intervention rate was highest in Poland (13.2%) and Brazil (17.2%). High intervention rates in Poland and Brazil has also been reported in previous studies(26-28). It has been suggested that variation in surgical intervention rates are due to differences in local clinical practices and economic incentives, rather than treatment efficacy or gestational length(28). We found an overall increase in the rate of complete abortion and decrease in surgical interventions between 2009 – 2019, which may be due to a combination of factors. Such as a rise of medical treatment of incomplete abortion, such as repeat doses of misoprostol, improved training of health professionals and increased knowledge about medical abortion process by women might have resulted in the decrease of surgical interventions(29).
Ultimately, further research is required to establish a more comprehensive understanding of contextual differences between countries to improve services and make telemedical abortions more accessible to women.