The California home abortion by telemedicine (CHAT) study: A proposal to test an innovative approach to abortion care
Awarded 2018
Increasing access to medication abortion
Ushma Upadhyay, PhD, MPH
University of California, San Francisco

Background: New strategies are needed to help people overcome barriers to abortion and achieve greater reproductive autonomy. Demedicalized models for medication abortion care have the potential to greatly expand access to abortion, particularly for those most affected by distance and cost barriers.
Methods: The study is a patient-centered, clinically supported, prospective observational study among people in California seeking medication abortion. We will evaluate the feasibility, efficacy, and acceptability of a demedicalized model of abortion care that removes the necessity for participants to come to a clinic for pre-abortion care by offering optional orders for pre-abortion tests. This study will employ four study clinicians to oversee that participants meet enrollment criteria, follow study protocol, and will be available to participants 24/7. The study will aim to recruit 3,000 patients over 3 years and will use both quantitative and qualitative data to address research questions that focus on feasibility, time to care, efficacy, safety, and acceptability of the demedicalized model of medication abortion provision.
Proposed analysis: We will compare outcomes of the demedicalized medication abortion model patients to in-clinic medication abortion patients in the published literature and to all in-clinic University of California, San Francisco medication abortion patients treated over the same period (n approximately 300). The theory that this model can make a significant impact on people’s access to early abortion is based on what we know about abortion availability, abortion safety, patient preferences, patient behaviors, and the changing medical landscape.