Early Telemedical Abortion, Safeguarding, and Under 18s: a qualitative study with Care Providers in England and Wales

Objective To explore the views and experiences of healthcare professionals in England and Wales in carrying out their safeguarding duties with people aged under 18 in the shift to telemedical early medical abortion. Design Qualitative study involving online semi-structured interviews and reflexive thematic analysis. Setting England and Wales. Population Twenty healthcare professionals working at abortion care providers based in England and Wales. Methods Audio-recorded, semi-structured interviews generated data on abortion providers’ views and experiences of safeguarding in telemedical abortion care. Recordings were transcribed verbatim and then subject to reflexive thematic analysis. Main Outcome Measure Themes identified through reflexive thematic analysis of interview transcripts. Results While the study was designed with adult safeguarding in mind, the safeguarding of under 18s became a key area of discussion. Three major themes were constructed in relation to under 18s: (1) age as a risk factor in safeguarding; (2) telemedicine as improving access to care; and (3) telemedicine as enhancing communication. Conclusion Care providers believe telemedicine abortion has benefitted U18s. There was a strong feeling both that telemedical early medical abortion had improved access (which, in turn, improved safeguarding) and that U18s were comfortable communicating using remote means. Providers believe safeguarding proformas must account for the different nature of risks where service users are U18, but that it is disproportionate to assume that telemedical early medical abortion is unsuitable for all U18s. Funding: Funded by the Institute of Medical Ethics.