Table 1 Characteristics of included studies and their main finding

1

Aiken et al. [30]

Descriptive

8 European countries

3915 pregnant women

–

Increases in requests to access to medical abortion by telemedicine and demand for self-managed medical abortion

–

travel restrictions

–

Five countries showed significant increases in requests to Women on Web (WoW), ranging from 28% in Northern Ireland to 139% in Portugal

8

2

Aiken et al. [28]

Descriptive

USA

49,935 pregnant women

(Up to 10

weeks)

–

27% increase in the rate of requests for self-managed abortion and online telemedicine

Shifting in demand from in-clinic to self-managed abortion

–

lockdowns

–

Eleven states showed significant increases in requests, ranging from 22% in Ohio to 94% in Texas

Increases in requests in states with the longest lasting restrictions

7

3

Atay et al. [22]

mixed-methods

(Cross-sectional-Content

Analysis)

France

809

Pregnant women

5 weeks < 

Median 29 (11)

Demand for at-home medical abortion via teleconsultation

–

lockdowns

–

The most frequent reasons to choose telemedicine abortion was privacy (38.3%) secrecy (46.2%) and comfort (34.9%)

8

4

Aryal et al. [17]

Cross-sectional

Nepal

52 pregnant women

(9.5- 7.5 weeks)

24.67 ± 4.08

Demand for SAS (Safe Abortion Services) decreased in 47.1%

Individuals came at a later GA with a mean of9.5 weeks compared to 7.5 weeks. more women favorite medical abortion compared to surgical abortion

No significant difference in satisfaction towards services in lockdown and after it (p = 0.69)

Fear of COVID-19

19.2% individuals wanted termination of pregnancy in line for to fear of COVID-19

7

5

Boydell et al. [20]

Qualitative (Thematic analysis)

Scotland

20 pregnant women

(Up to 12 weeks)

18–39

Expansion of a direct-to-patient telemedicine medical abortion/the quality of abortion care was improved in telemedicine service due to access, comfort, flexibility, and ongoing telephone support

Women accept telemedicine medical abortion at home

–

–

–

–

6

Chong et al. [26]

Descriptive

USA

1356 pregnant women

(6 weeks)

15–47

85% was very satisfactory with TelAbortion

–

Transfusions (0.4%)

TelAbortion service was safe, effective, and acceptable

6

7

De Kort et al. [31]

Descriptive

Belgium

4 abortion centres

–

The number of applications for abortion in the clinic decreased. Individuals request an abortion earlier in their pregnancy

–

Individuals using modern contraception and in paid employing

Negative impact on the psychological support

Individuals using modern contraception and employing in paid had more reduced abortion requests in clinic

6-

8

De Kort et al. [25]

Qualitative

(Phenomenological, abortion centre staff experiences)

Belgium

7 psychosocial staff members and 3 doctors

–

A general drop in abortion requests and procedures in abortion center. Technical and medical quality of abortions did not decline during the lockdown

–

–

–

People were more likely to request an abortion earlier in their pregnancy. Staff reported feeling stressed, tired, and frustrated

–

9

Gibelin et al. [24]

Retrospective

France

124 health workers performing abortions

–

The majority of abortion providers (76.6%) approved and followed medical abortion at home between 7–9W and 61.7% offered telemedicine for medical abortion at home

–

–

Bleeding, pain, hemorrhagic abortion

The French National Health Agency has urgently recommended telemedicine and consultations for medical abortion at home for 7–9 weeks pregnancies. This measure may be extended after pandemic

6

10

Godfrey et al. [32]

Cross-sectional

USA

534 pregnant women

(10 weeks)

14–50

Direct delivery of medication abortion, online counseling, and care service from Aid Access

-

Location and distance from hospital

–

-71% lived in urban areas

-24% lived in high Social Vulnerability Index (SVI)

-26% living in medium–low SVI

7

11

Karlin et al. [33]

Prospective (interview and survey)

USA

40 abortion providers

–

Examining the change in the way clinics work and attitudes about self -sourced medication Telemedicine

management abortion changes to the using of self-sourced medication

Believe about self-sourced medication abortion: Safe, effective, and empowering (50%)

Ambivalent but safe and valid (45%)

Unsafe (5%)

–

-

Another abortion protocol that clinics had was increasing gestational age limit to more than half

After Covid 19, the need for in-clinic evaluation decreased and women find ultrasound less necessary before an abortion (decrease to 50%) or confirm pregnancy (decrease to 61%)

7

12

Kerestes et al. [23]

Retrospective cohort

USA

334 pregnant women (11 weeks) who had medication abortion

–

Success rate of abortion medication through telemedicine was 96.8, 97.1, and 93.6% for the clinic pickup, mail, and in person visit respectively. The effect of the medication abortion without surgical intervention was 95.8%

Telemedicine is satisfactory

–

Transferring emergency room (11), Blood transfusion (2), Receiving additional misoprostol (4)

149 patients received telemedicine with in-person pickup of medications, 75 patients via telemedicine with medications mailed, and 110 patients via traditional in person visits

Using of medication abortion and present telemedicine service without ultrasound

8

13

LaRoche et al. [21]

Mixed method study

USA

711

48.3

Using medication abortion and telemedicine. people’s opinions about telemedicine to medication abortion

Using tele-medical abortion: agree (44%), disagree (35%), uncertain (21%)

Political reasons, when the life of the fetus begins, Safety

–

–

14

Romanis and Parsons [29]

Newspaper’s article

UK

–

–

Telemedicine services for early medication abortion (TEMA) minimize one’s contact with others

TEMA is safe, effective and satisfying

Distance from the nearest clinic

–

Somegovernments have banned abortion under any circumstances

–

15

Reynolds-Wright et al. [34]

prospective observational cohort

UK

663 pregnant women

(12 weeks)

27.6

Using medical abortion at home with telemedicine services without routine ultrasound

83%: very acceptable

3.6: somewhat acceptable

–

Bleeding 2.4%

Pain 2%

98% of women had a complete abortion, (0.8%) an ongoing pregnancy and (0.6%) an incomplete abortion

8

16

Andersen et al. [18]

Cross-sectional

USA and Columbia

317 clinics

–

Abortion restrictions have reduced the number of visits to abortion clinics by 32%

–

–

–

Areas where abortion is prohibited have an additional 23% reduction to visit the clinic

7

17

Marquez-Padilla et al. [19]

Cross-sectional

Mexico

Mexico City’s public abortion program data

–

The impact of stay-at-home orders on abortion

–

–

–

Stay at home can reduce abortions by at least 25%

7