Strengths and limitations
A key limitation is the low response rate, which appeared to decrease
over time. If the likelihood of responding was related to the patient’s
experience and outcome, then this would be a source of bias in our
results. A loss to follow-up is to be expected and is a persistent
challenge within abortion research given the high level of stigma
associated and the legally restricted settings(8,
23). Other limitations include the use
of self-reported data. However, given that the sample was overwhelmingly
in legally restricted settings and in an informal healthcare setting,
using self-reported data is the most feasible method(21). We could not
adjust for known confounders, such as gestational age, as this
information was not available in this dataset(22). However, as WoW
limits the availability of the service to women who are less than 9-10
weeks gestation, the the abortions in this dataset are expected to have
taken place in the first trimester. To our best knowledge, this study
provides the largest evaluation of the outcome of self-managed abortions
provided by telemedicine. Furthermore, it includes the largest sample of
women in legally restricted settings. Outcomes are reported in
consistency with prior studies for comparability. In addition, we
included outcome measures which have never been looked at before such as
prior knowledge about medical abortion.