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Journal ArticleDOI

Early medical abortion, equality of access, and the telemedical imperative

TL;DR: The authors of Early medical abortion, equality of access, and the telemedical imperative argue that any society that claims to hold evidence-based healthcare in high regard has a moral obligation to introduce, retain, or reinstate TEMA to protect and promote the health of pregnant people.
Abstract: Early medical abortion via telemedicine (TEMA) is safe, effective, and acceptable to both patients and providers. Given this strong evidence base, the authors of Early medical abortion, equality of access, and the telemedical imperative argue that “any society that claims to hold evidence-based healthcare in high regard has a moral obligation to introduce, retain, or reinstate (as applicable) TEMA to protect and promote the health of pregnant people” (p.xxix). Building upon Parsons’ proposed “telemedical imperative” and drawing on the case studies of the United Kingdom and the United States, Parsons and Romanis are concerned with abortion access and advocating for TEMA as one choice among many in patientcentred reproductive health. Although COVID-19 prompted the legalisation of full TEMA in England, Scotland, and Wales and at the federal level in the US, the authors lament that “it took a global pandemic and the resulting near impossibility of providing adequate abortion services to finally push those in power to make changes that enabled TEMA provision” (p.xxiii). Nevertheless, this book does not take COVID-19 as its starting point – the moral imperative to implement TEMA existed prior to the pandemic. The authors begin by correctly reminding the reader that TEMA is “not a speculative proposal” (p.xxiv); for most of the twenty-first century, abortion providers have been implementing “full” and “partial” TEMA within and outside of national regulatory frameworks. Although TEMA has been proven to be successful in terms of safety, effectiveness, and acceptability, its implementation has been hindered by socio-legal barriers to abortion. In both the UK and US, abortion policy dictates who can have an abortion, when, where, and how. That abortion is subject to such extensive – and unnecessary – regulation is, as the authors argue, a sign of its exceptionalism under the law. Under the guise of pregnant people’s safety, abortion regulations in both countries serve only to limit access to abortion. The authors suggest that abortion policy in the UK “cannot rightly be described as evidence based” but could generously be “characterised as evidence informed” (p.70), whereas in the US the “landscape of access is devastating” (p.55). The telemedical imperative, further developed here from Parsons, is the duty for health care systems to implement telemedicine where it is safe, effective, and acceptable and there are no service-specific concerns. The authors successfully make the case for early medical abortion (EMA) satisfying these conditions in both countries. First, the evidence reviewed in this book demonstrates the safety, effectiveness, and acceptability of TEMA. Second, the authors address servicespecific concerns such as clinic closures resulting from the uptake of TEMA, issues with safeguarding via telemedicine, and the ability to successfully date pregnancies without in-person care. They rightly conclude that these concerns are “insufficient to deny the telemedical imperative in the case of EMA” (p.93). The authors outline several convincing benefits of TEMA: overcoming health inequalities, improving efficiency, and enhancing autonomy of service users. The authors concede that TEMA is not a “silver bullet in the context of abortion care” (p.75). Rather, they argue that telemedicine is “a way of enablingmore people to access care that is already available to them” (ibid.). Indeed, they reject the idea that in-person services become an “option B”, which presupposes that telemedicine is somehow better. For the authors, TEMA is “additional and not substitutionary” (p.76). The authors caution that TEMA and in-person services are not a simple either/or. Instead, they offer a useful “telemedical continuum” that extends from no remote BOOKSHELF
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