Comparing contraceptive requests and initiation following in-person versus telehealth medication abortion

Compare post-abortion contraception (PAC) requests at initial consultation and PAC method initiation at follow-up between people seeking telehealth and in-person medication abortion.

This is a retrospective cohort study of all medication abortions performed by the University of Hawai'i Options Center between 2019 and 2021. Using electronic health records, we collected data on patient demographics, clinical characteristics, receipt of contraceptive counseling, PAC method requested at initial consultation, and PAC method initiated at follow-up.

Of 681 medication abortion patients, 341 received initial consultation in-person and 340 via telehealth. At initial consultation, contraceptive preferences differed significantly (p < 0.01), with a greater proportion of telehealth patients undecided or without a stated preference (36.5% telehealth vs. 27.3% in-person). Of patients who followed up, those who had their initial consultation in-person were significantly more likely to have initiated a form of contraception at the time of follow-up (30.0% telehealth vs. 52.0% in-person, p < 0.001). Of the patients who initiated contraception, those who had their initial consultation in-person more frequently initiated provider-dependent methods such as long-acting reversible contraceptive methods (19.1% telehealth vs. 39.3% in-person) and injectable contraception (4.5% telehealth vs. 12.1% in-person).

Patients receiving medication abortion care via telehealth were less likely to have a contraceptive preference at initial consultation and less likely to have initiated a contraceptive method at follow-up. Telehealth patients also initiated provider-dependent methods less frequently than in-person patients. PAC initiation may be subject to the same barriers that impact access to abortion, and attention is needed to ensure equitable contraceptive access in communities.

These findings indicate a difference between PAC preferences based on mode of medication abortion delivery, highlighting a need to address contraceptive service availability, particularly for provider-dependent methods, in areas with limited access to in-person reproductive health care.