Introduction Women on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector. In April 2019 they opened their helpdesk to Germany. Our aim was to understand the motivations, and perceived barriers to access, for women who choose telemedicine abortion outside the formal health sector in Germany. Methods We conducted a parallel convergent mixed-methods study among 1090 women consulting WoW from Germany between 1 January and 31 December 2019. We performed a cross-sectional study of data contained in online consultations and a content analysis of 108 email texts. Analysis was done until saturation; results were merged and triangulation used to validate results. Results The quantitative analysis found that the need for secrecy (n=502, 48%) and the wish for privacy (n=500, 48%) were frequent reasons for choosing telemedicine abortion. Adolescents were more likely to report secrecy, cost, stigma and legal restrictions as reasons for using telemedicine abortion compared with older women. The content analysis developed two main themes and seven subsidiary categories, (1) internal motivations for seeking telemedicine abortion encompassing (i) autonomy, (ii) perception of external threat and (iii) shame and stigma, and (2) external barriers to formal abortion care encompassing (iv) financial stress, (v) logistic barriers to access, (vi) provider attitudes and (vii) vulnerability of foreigners. Conclusions Women in Germany who choose telemedicine abortion outside the formal health sector do so both from a place of empowerment and a place of disempowerment. Numerous barriers to abortion access exist in the formal sector which are of special relevance to vulnerable groups such as adolescents and undocumented immigrants. All original data are available upon reasonable request to the researchers.

中文翻译：

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为什么女性选择通过德国正规卫生部门以外的远程医疗进行堕胎：一项混合方法研究

简介 Women on Web (WoW) 是一项在正规卫生部门之外运营的全球药物流产远程医疗服务。2019 年 4 月，他们在德国开设了服务台。我们的目的是了解在德国正规卫生部门之外选择远程医疗堕胎的女性的动机和感知障碍。方法 我们在 2019 年 1 月 1 日至 12 月 31 日期间对来自德国的 1090 名咨询 WoW 的女性进行了一项平行收敛的混合方法研究。我们对在线咨询中包含的数据进行了横断面研究，并对 108 封电子邮件文本进行了内容分析。分析一直进行到饱和；结果被合并并使用三角测量来验证结果。结果 定量分析发现需要保密（n=502, 48%）和希望隐私（n=500, 48%）是选择远程医疗堕胎的常见原因。与老年妇女相比，青少年更有可能将保密、成本、耻辱和法律限制作为使用远程医疗堕胎的原因。内容分析制定了两个主题和七个子类别，(1) 寻求远程医疗堕胎的内部动机，包括 (i) 自主权，(ii) 对外部威胁的感知和 (iii) 羞耻和耻辱，以及 (2) 正式的外部障碍堕胎护理包括 (iv) 经济压力，(v) 获取后勤障碍，(vi) 提供者态度和 (vii) 外国人的脆弱性。结论 选择正规卫生部门以外的远程医疗堕胎的德国妇女是从赋予权力的地方和剥夺权力的地方这样做的。正规部门存在许多阻碍堕胎的障碍，这些障碍与青少年和无证移民等弱势群体特别相关。所有原始数据均可根据研究人员的合理要求提供。