Transnistria is a separatist region internationally recognized as a part of Moldova, bordering Ukraine. Many Ukrainian refugees are living in the Republic of Moldova and Transnistria and 90% are women with children. This of course heightens the existing need for good quality and effective reproductive health care across the region.
At the Reproductive Health Training Centre we are proud to have introduced telemedicine abortion to the Republic of Moldova. In early 2020 we carried out a groundbreaking pilot study aiming to deliver abortion medication to 100 participants. Unexpectedly, the COVID-19 pandemic lockdown accelerated the study’s enrollment to five times the target, with a remarkable 99% satisfaction rate and only 0.5% complications.
The initiative proved to be a well-timed blessing, demonstrating that women are smart, capable, and responsible enough to manage their health autonomously.
However, due to the border, those in Transnistria were not yet able to benefit from this service.
With continued funding from SAAF we therefore set about bringing the same learning and best practices to the region of Transnistria. After extensive discussions with the local Ministry of Health and community stakeholders, the decision was made to build the capacity of local doctors and launch a pilot study to bring the option of telemedicine abortion to Transnistria.
In June 2023 we launched a pilot study with a target of 50 participants. The demand turned out to be so high that the pilot study expanded, adding six more providers from three new cities, and increasing the participant count to 100.
The results were outstanding: 100% of participants reported being satisfied or very satisfied, and 99% expressed a willingness to choose this method in the future. Additionally, 97% said they would recommend it to others.
Participants praised the convenience and confidentiality of receiving medical abortion by telemedicine.
72% of participants said that they valued the convenience of receiving abortion pills remotely.
The process begins with an individual visiting the website reproducthealth.md and filling out an eligibility questionnaire. Once deemed eligible, the system assigns the individual to the next available provider. After a consultation with the doctor and providing informed consent, the patient can either pick up the medication from a pharmacy with an electronic prescription or have it delivered by mail. Once the medication is received, the doctor contacts the patient with step-by-step instructions on how to take it.
Those who accessed the service told us they also appreciated reduced time away from work or school, and fewer clinic visits. Of course, for those with children this also meant a reduced or eliminated need for childcare. Positive feedback also highlighted the absence of cost, rapid consultation, and psychological ease.
The criticisms were minimal, with 95% reporting no weak aspects and only 5% mentioning unclear instructions. Participants shared their positive experiences:
“It was exciting to be the first in the pilot. They explained everything thoroughly over the phone, provided printed information, and gave me the pills to take myself. I knew I could always call the experts. I loved it.”
“I am very happy that I don’t have to find someone to leave my child with.”
“We are glad that progress has reached us through telemedicine.”
Despite historical tensions between Moldova and Transnistria, this collaborative effort in healthcare has shown that progress is possible.
The success of this pilot study, with enthusiastic support from local authorities and providers, highlights a significant step forward for the community. The updated protocol, aligned with the latest WHO recommendations, is ready for approval, and plans for scaling up include training more providers and increasing access for the entire community.
By embracing medical abortion via telemedicine, both regions have taken a significant step towards empowering women and improving community health.
By Catalina Comendant, Project Assistant and Rodica Comendant, Project Coordinator at Reproductive Health Training Centre (RHTC), a SAAF grantee partner organisation based in Moldova.