October 2023

Lessons learned from developing and implementing digital health tools for self-managed abortion and sexual and reproductive healthcare in Canada, the United States, and Venezuela

Luigi-Bravo G, Ramirez A, Gerdts C, Gill RSexual and Reproductive Health Matters. October 2023. DOI: 10.1080/26410397.2023.2266305

The use of digital health interventions and tools has been in the mainstream since at least the early 2000s. However, in the last decade, there has been a boom in innovation and implementation of digital health interventions in the sexual and reproductive health (SRH) field. People have increasingly turned to digital devices for medical information and decision-making, whether searching for symptoms online or using mobile applications to connect with healthcare providers. Reproductive health information is no exception. Need to track your period? There are many apps for that! Need to find a reproductive health clinic? Geolocalised directories have your back. The offer expands to digital platforms focused on menstrual and hormonal health, contraception, fertility awareness, sexual health information, counselling, and so on. Abortion care is no exception to this trend. As the abortion access landscape shifts within a spectrum of legal restrictions, digital health tools like telemedicine platforms, mobile applications, and even social media have become valuable resources to counter restrictive legislation as well as to innovate in healthcare provision.

The availability of abortion medication and information about its safe self-management are essential factors in the decision-making process of having an abortion. Digital tools can help users navigate this process. Digital health interventions have been used in global and public health to self-assess eligibility for medical abortion, support the self-administration of medication, assess medical abortion completion, and inform users about post-abortion contraception options. Similarly, innovation in digital abortion care has also entered the “FemTech” space, a term coined in 2016 by Ida Tin, founder of Clue, a period and ovulation tracking app. This term is meant to encompass health solutions, often digital-based, geared towards cisgender women’s health issues primarily focused on reproductive health-related experiences, including both abortion and miscarriage care. While there is no question as to whether users want access to crucial reproductive health information and tracking, there should be a pause to ask how these digital tools have been developed, how end-users are using them, and the range of implications for their health and wellbeing.

Digital health is a broad term referring to the systematic implementation of information and communications technologies, computer science, and data to support informed decision-making by individuals and improve health and wellness outcomes. These interventions can potentially address problems such as distance and access to abortion care, especially in legally restrictive settings where in-clinic abortion care is unavailable. Still, digital health tools for abortion care share many of the underlying challenges faced by the health system: for instance, infrastructure limitations reflected on user experience issues, data privacy and management concerns, and how these tools interact with the healthcare systems at large. These matters need to be addressed in addition to the specific implementation requirements of digital health interventions. They range from ethical and safeguarding issues like the protection of users’ data from third parties to accessibility in communities with poor internet and data or where the population has a low digital literacy.

Considering these challenges, this commentary aims to outline what we have learned from developing and implementing three digital health tools for abortion and miscarriage care in Canada, the United States, and Venezuela. These interventions fall into a subset of digital health called mHealth, defined as the use of mobile wireless technologies for healthcare. We group lessons learned into three main categories: human-centred design, data and digital security considerations, and integration with formal health systems and community-based organisations. The geographical focus responds to the current implementation of projects aimed at tackling specific contextual needs. My PostCare in Canada addresses the lack of focused resources for miscarriage care in countries with broad reproductive healthcare access. Euki, developed in the United States but available worldwide, fills the gap of a free, simple, and accurate informational tool and data privacy-oriented period tracker. Finally, Aya Contigo in Venezuela was developed to support self-management and trusted referral access in restricted settings. Our hope is that these insights from mHeath development can serve others working to increase safe abortion access through high-quality and ethical digital health innovation.