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Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis

The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-s...

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Autores principales: Larrea, Sara, Palència, Laia, Assis, Mariana Prandini, Borrell, Carme
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9764217/
https://www.ncbi.nlm.nih.gov/pubmed/36560973
http://dx.doi.org/10.3389/frph.2022.1040640
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author Larrea, Sara
Palència, Laia
Assis, Mariana Prandini
Borrell, Carme
author_facet Larrea, Sara
Palència, Laia
Assis, Mariana Prandini
Borrell, Carme
author_sort Larrea, Sara
collection PubMed
description The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-sectional multilevel study to assess the effect of individual and contextual social factors on utilization of one such service. For the individual-level, we analyzed data from the records of abortion seekers contacting this feminist international telehealth organization during 2019 (n = 25,920). Individual-level variables were age, race, education level and pregnancy length. Contextual-level units were states, for which we used data from the national Demographic Census and Household Surveys. Contextual-level variables were household income per capita, adjusted net school attendance rate, percentage of racialized women and income Gini Index. We fitted five multilevel Poisson Mixed-effects models with robust variance to estimate prevalence ratios (PR) of service utilization, which was defined as receiving abortion pills through the service. We found that only 8.2% of requesters got abortion pills through the service. Utilization was higher among women who were older, white, more educated and 5–8-weeks pregnant. Independently of this, service utilization was higher in states with higher income and education access, with lower proportions of racialized women, and located in the South, Southeast and Central-West regions. We concluded that while feminist telehealth abortion initiatives provide a life-saving service for some abortion seekers, they are not fully equipped to overcome entrenched social inequalities in their utilization, both at individual and contextual levels.
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spelling pubmed-97642172022-12-21 Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis Larrea, Sara Palència, Laia Assis, Mariana Prandini Borrell, Carme Front Reprod Health Reproductive Health The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-sectional multilevel study to assess the effect of individual and contextual social factors on utilization of one such service. For the individual-level, we analyzed data from the records of abortion seekers contacting this feminist international telehealth organization during 2019 (n = 25,920). Individual-level variables were age, race, education level and pregnancy length. Contextual-level units were states, for which we used data from the national Demographic Census and Household Surveys. Contextual-level variables were household income per capita, adjusted net school attendance rate, percentage of racialized women and income Gini Index. We fitted five multilevel Poisson Mixed-effects models with robust variance to estimate prevalence ratios (PR) of service utilization, which was defined as receiving abortion pills through the service. We found that only 8.2% of requesters got abortion pills through the service. Utilization was higher among women who were older, white, more educated and 5–8-weeks pregnant. Independently of this, service utilization was higher in states with higher income and education access, with lower proportions of racialized women, and located in the South, Southeast and Central-West regions. We concluded that while feminist telehealth abortion initiatives provide a life-saving service for some abortion seekers, they are not fully equipped to overcome entrenched social inequalities in their utilization, both at individual and contextual levels. Frontiers Media S.A. 2022-12-06 /pmc/articles/PMC9764217/ /pubmed/36560973 http://dx.doi.org/10.3389/frph.2022.1040640 Text en © 2022 Larrea, Palència, Assis and Borrell. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Reproductive Health
Larrea, Sara
Palència, Laia
Assis, Mariana Prandini
Borrell, Carme
Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis
title Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis
title_full Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis
title_fullStr Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis
title_full_unstemmed Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis
title_short Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis
title_sort social inequalities in utilization of a feminist telehealth abortion service in brazil: a multilevel analysis
topic Reproductive Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9764217/
https://www.ncbi.nlm.nih.gov/pubmed/36560973
http://dx.doi.org/10.3389/frph.2022.1040640
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