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Theme Description Illustrative Quotes Ease of process of obtaining telemedicine medication abortion in primary care Patient-centered counseling and preparation Participants reflected on having effective, patient-centered counseling throughout their TeleMAB experience and having clearly communicated instructions on how to use the medications and what to expect. Clinicians were also perceived as kind and non-judgmental. This enhanced participants’ comfort and confidence with their TeleMAB. #1 “Everything went well, the support they gave me, the information they gave me was complete and the process was exactly like the doctor told me it was going to be and everything turned out fine.” (ID 3, age 28)
#2 “She called again, [after the initial consultation], offered me support and she guided me through the steps on how to take medicine, what I’d feel, any side effects, if there were any issues - that they’re just a phone call away… Very friendly. And again, they were great as far as support and everything.” (ID 10, unknown age)
#3 “Just dealing with people, making medication easy and making it simple to understand how to take it, the whole experience for me, someone who didn’t plan to be pregnant, it was the most easy experience I’ve ever been through. And I would never have ever expected to go through an abortion experience like that, to be so simple.” (ID 33, age 26)Simplicity of the service Participants found the process of scheduling appointments, contacting providers, and using the medication delivery system familiar, simple, easy, and reliable. #4 “So, every time I needed to speak to her or set up an appointment, I was able to get a hold of either her or the other doctor that was in my case. They were there when I needed help.” (ID 48, age 31)
#5 “They set up a date to send the medication to my home, and a person delivered it to my hand. I had to sign the form, and I did the procedure at night.” (ID 15, age 31)
#6 “I trusted [the primary care system] and I knew how the process went, and I knew some of the people, and how things would go… I know how to message them and how to call them. Things like that made it feel familiar and easy to engage in. … Versus, I’ve never actually talked to anyone at [an abortion clinic] ever. So I’d have to figure out how to even set it up. So, I didn’t have to go through that process.” (ID 46, age 34)Familiarity and trust in primary care system Existing relationships and familiarity within one’s primary care system made participants feel more comfortable navigating their abortion care. #7 “Yeah, so prior to my first pregnancy, [my primary care doctor is] who I see for everything. So I didn’t have to worry about finding new doctors for anything. She’s who I go to.” (ID 48, age 31)
#8 “I felt more comfortable because I’ve been here for a minute, it’s not my first pregnancy scare [with this clinic], so I knew that I could trust in them and rely on them.” (ID 33, age 26)
#9 “I’ve always had my PCP [in the health system] and that’s where I had my baby and got all my care around that pregnancy and had really great experiences.” (ID 46, age 34)Advantages of telemedicine Flexibility over where and when to take the appointment Telemedicine allowed participants to take appointments in places and times that fit into their lives, reducing logistical, financial, health, and time-related burdens. #10 “The televisit is convenient. It saves you time to move around. For instance, I have kids, so honestly, everywhere I will be going, I will be going with them, because I have no one to stay with them… And also the transport fare. I don’t drive, so I have to transport myself to the hospital. Then the stress of looking after the kids, while I, at the same time, see the doctor, and all the examination processes. So [telemedicine] was quite convenient for me.” (ID 53, age 34)
#11 “It was fine. It was actually a slow day [at work], so thankfully I was able to talk to my doctor and get everything that I needed… I had my headphones in so nobody really got to hear the conversation. I was able to answer the questions that needed to be answered, and just be able to take those next four steps.” (ID 33, age 26)
#12 “They gave me the option of going to the clinic or having the appointment over the phone and I felt really comfortable doing it over the phone.” (ID 3, age 28)Autonomy and control Telemedicine options afforded participants greater autonomy and control over their space, emotions, and overall experience. They felt more comfortable taking care of their needs in the comfort of their homes. #13 “I was actually really sick during that pregnancy. I was vomiting the whole time up until the end of the abortion. So that was definitely a plus of not having to leave the house and be able to be in the comfort of my home and have the visits there” (ID 10, age unknown).
#14 “You could just be transparent and bare and not have to worry about being stripped in front of someone…Having done both, I would go virtual again a billion times over… I was able to be more free with [my clinician]… And I could light a cigarette or if I needed to pace around or move or get ice water or anything, it was all at my disposal right there… They gave me control of a situation that was uncontrollable to me and was freaking me out … I felt very in the driver’s seat.” (ID 9, age 32)Primary care normalizes abortion care Continuity of care Participants felt more comfortable having abortion care in the primary care setting because their provider knew them and their needs and could take care of them in the full context of their health and social histories. #15 “Yes, I like [abortion services provided at a primary care center]. It’s a great clinic, where you can get treatment for everything. It’s nice. It’s because when you see an abortion clinic, it feels like a strange place. A place dedicated to abortions. It sounds strange. However, when it’s a hospital where they treat all kinds of diseases and offer many treatments, it sounds better.” (ID 15, age 31) Primary care as a protective force Participants felt their primary care providers helped reduce feelings of isolation, affirm their decisions, and mitigate difficult situations. #16 “I’m a very traumatized person. I had a lot of childhood trauma and they just put ease in my life for the first time. I was just so appreciative. Because kindness isn’t owed to you, it’s something given as a gift… [the clinician] didn’t have judgment on me.” (ID 9, age 32)
#17 “I didn’t know that it was going to go so bad… but I kept my cries in and I was able to talk to [the primary care doctor] about it. I just told him that I totally appreciate him being there for me because, besides the boyfriend, I had nobody else that I could speak to about everything that I went through.” (ID 54, age 33)
#18 “I was being pressured (by the CPC) to make a different decision than what I came here for, but they want to try to tell me that they understand me and that they feel my emotion. You don’t feel my emotion or understand my decision, if you’re trying to force me to do something that I’ve even planned to come here to do.” (ID 33, age 26)CPC = crisis pregnancy center; PCP = primary care physician; teleMAB = telemedicine medication abortion.
Note: Fourteen Massachusetts women of reproductive age were interviewed in 2022. Excerpts have been edited for clarity.
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