Access to termination of pregnancy services by telephone or video conference consultation

The current model of care for early medical abortion, which was introduced as a pandemic measure, allows healthcare providers to offer care via phone or video consultations. Telemedicine abortion has proven a positive development that is patient-centred, enables choice, and enhances access to care. I have called on the Minister for Health for its retention.

I recently wrote to the Minister for Health to urge him to retain the option to access termination of pregnancy services by telephone or video conference consultation, as recommended as an option by the International Federation on Gynaecology and Obstetrics (FIGO), Royal College of Obstetricians and Gynaecologists (RCOG), and the National Institute for Health and Care Excellence (NICE). You can find this letter below.

Dear Minister,

I am contacting you in relation to retaining the option of accessing termination of pregnancy services by telephone or video conference consultation, i.e. via Telemedicine. This could be achieved by a revision of the HSE model of care to remove the reference to Telemedicine as a pandemic measure.

The current model of care for early medical abortion, which was introduced as a pandemic measure, allows healthcare providers to offer care via phone or video consultations. Telemedicine services enabled people to continue accessing early medical abortion care throughout the strictest phases of the pandemic public health measures. It has been integral to the model of care for early abortion for two of the three years of legal abortion care in Ireland.

The evidence shows that Telemedicine is safe, and it is recommended by global reproductive health standard-setting bodies such as the International Federation of Gynaecology and Obstetrics, the UK Royal College of Obstetricians and Gynaecologists, and the UK National Institute for Health and Care Excellence (NICE). Telemedicine abortion is flexible and responsive to the needs of service users. Prior to the introduction of remote consultation, the model of care required all those who needed abortion care to have two in-person appointments with their healthcare provider, with the mandatory 3-day waiting period in between. This created an undue burden on pregnant people who needed to arrange time off work or education, or to arrange childcare; on those with disabilities or those living with the threat of domestic violence; and on those who lived at a distance from an abortion provider, far from the major cities and/or relied on public transport. The option of telemedicine consultation within the care pathway, as the primary mode of care during lockdowns and now as part of a blended model of care, helps to mitigate some of these access barriers.

A peer-reviewed article in the International Journal of Gynecology and Obstetricin May 2021 (https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.13720) highlights the positive experiences clients of the Irish Family Planning Association (IFPA) had of early medical abortion service using telemedicine. Service users reported a high level of acceptability, given it allowed for more privacy, enabled them to access care sooner, and meant they did not have to arrange childcare or incur other transport costs. International evidence demonstrates the benefits of telemedicine abortion: a national cohort study of 50,000 women in the UK found a telemedicine-hybrid model for abortion care is effective, safe, acceptable, and improves access to care (https://doi.org/10.1111/1471-0528.16668). Other countries are leading the way in providing patient-centred abortion telemedicine with New Zealand launching a 24-hour web-based telehealth service for abortion support in April 2022.

The current review of the 2018 abortion legislation is an opportunity to address barriers to access, learn from service users, and draw on international evidence and best practice to design a service that prioritises people’s right to reproductive health. Telemedicine abortion is a positive development that is patient-centred, enables choice, and enhances access to care. It is safe, and it is recommended by international best practice and standard setting bodies. It enhances access to care in the context of uneven distribution of early abortion care across Ireland. It expands women’s choices and reduces the burden of accessing care on particularly vulnerable groups. There is no evidence of any health-related reason to discard Telemedicine from the model of care for early abortion.

Therefore for all of these reasons, I am strongly urging you to ensure Telemedicine is retained as part of the care pathway for early medical abortion into the future.

Your Sincerely,

Neasa Hourigan TD

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