Research on Equity in Abortion Care by TeleHealth (REACH)

Improving Health Equity by Understanding Preferences in Telehealth Abortion

This study will examine the ways in which telehealth for reproductive healthcare affects timing, costs, and follow-up care; whether telehealth reaches people in areas with greater health inequities; and the attributes of telehealth that patients want. Study surveys will be administered to interested, eligible participants: 2,000 patients seeking abortion care will complete the study, comprising of 2 groups: patients seeking medication abortion care either (1) in-person or (2) via telehealth. This project will address how telehealth services can be optimized for people of color, low-income people, and immigrants to increase digital inclusion and health equity.

Study Overview

• Status: Recruiting
• Conditions: Abortion in First Trimester; Abortion Early; Abortion; Attempted

Detailed Description

Given the novelty of telehealth abortion services and new abortion bans, there is a critical need for research on the role of telehealth for abortion to expand equitable abortion access among groups historically marginalized in healthcare. Outside of abortion care, telehealth appears to 1) bridge geographic disparities,2) facilitate language translation,3) provide privacy and safety for immigrants with varying legal statuses, 4) decrease patient costs, and 5) require less time off work or school. At the same time, telehealth services could exacerbate inequities if patients lack technology, internet connectivity, or digital literacy. Because abortion is overregulated and highly stigmatized, research on telehealth for abortion is vital. The investigators hypothesize that telehealth is associated with several benefits compared to in-person abortion care, but is not yet reaching people in areas with greater health inequities who need these innovations most. This research can also inform the policies in states that are considering ways to support people in banned states.

• Study Type: Observational
• Enrollment (Estimated): 2000

Contacts and Locations

• Study Contact: Name: Ushma Upadhyay, PhD, MPH; Phone Number: 415-353-4626; Email: ushma.upadhyay@ucsf.edu
• Study Contact Backup: Name: Jennifer Ko, MLIS; Phone Number: 415-353-9113; Email: jennifer.ko@ucsf.edu

Study Locations

• United States
  • California
    • Oakland, California, United States, 94612
      • Recruiting
      • Advancing New Standards in Reproductive Health (ANSIRH)
      • Principal Investigator: Ushma Upadhyay, PhD, MPH
      • Contact: Jennifer Ko, MLIS; Phone Number: 415-353-9113; Email: jennifer.ko@ucsf.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Participants who have recently received or are currently seeking medication abortion, either through in-person or telehealth services will be able to participate on this study. Up to 1,000 participants will be enrolled through established clinics that offer in-person and telehealth services (500 in-person clinic patients; 500 telehealth patients). Up to 1,000 participants will be enrolled online via Google Ads or other online outreach methods (500 in-person clinic patients and 500 telehealth patients).

Description

Inclusion Criteria:

• Must be currently or about to be obtaining medication abortion care through in-person or telehealth services

Exclusion Criteria:

• Not currently or about to be obtaining medication abortion care through in-person or telehealth services

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort
In-person via established clinic; People seeking or who have received in-person medication abortion care through an established clinic.
Telehealth via established clinic; People seeking or who have received telehealth medication abortion care through an established clinic. A telehealth medication abortion involves a remote clinical consultation to confirm medical eligibility with medications delivered by mail
Telehealth through other online services or searches; People seeking or who have received telehealth medication abortion care through an online service
In-person through online search; People seeking or who have received in-person abortion services through online searches

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Determine the ways in which telehealth services affect timing and time to care by comparing in-person and telehealth patients	Descriptive statistics for the elapsed days from the first pregnancy test to 1) date of the decision to have an abortion, 2) date of first contact with the clinic, 3) date of medication receipt, and 4) date mifepristone (the first medication) was ingested.	Baseline
Determine the ways in which telehealth services affect costs by comparing in-person and telehealth patients	Report of 1) out-of-pocket costs for the abortion and 2) the costs of related expenses, including transportation, childcare, lost work, and other expenses.	Baseline and 1 week
Determine the ways in which telehealth services affect follow-up care by comparing in-person and telehealth patients	The incidence of unplanned in-person follow-up visits to a clinician, emergency room, or other facility, between participants in the telehealth and in-person groups using logistic regression models.	1 week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Investigate the patient preferences for different aspects of telehealth for abortion care among historically marginalized groups	We will conduct a discrete choice analysis to understand participant preferred choices for hypothetical delivery alternatives to telehealth abortion.	Baseline and 1 week
Investigate the barriers in telehealth for abortion care in historically marginalized groups	The barriers to hypothetical delivery alternatives to telehealth abortion between participants in the telehealth and in-person groups using a discrete choice model	Baseline and 1 week

Collaborators and Investigators

• Sponsor: University of California, San Francisco
• Collaborators: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Ibis Reproductive Health
• Investigators: Principal Investigator: Ushma Upadhyay, PhD, MPH, University of California, San Francisco

Study record dates

Study Major Dates

• Study Start (Actual): February 12, 2025
• Primary Completion (Estimated): August 31, 2026
• Study Completion (Estimated): August 31, 2026

Study Registration Dates

• First Submitted: April 5, 2024
• First Submitted That Met QC Criteria: January 17, 2025
• First Posted (Actual): January 22, 2025

Study Record Updates

• Last Update Posted (Actual): April 8, 2026
• Last Update Submitted That Met QC Criteria: April 6, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: telehealth; medication abortion; health equity
• Additional Relevant MeSH Terms: Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Abortion, Spontaneous
• Other Study ID Numbers: 23-39122; R01HD110659 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No