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.