The Impact of COVID-19 on Abortion Care

COVID-19 caused urgent effects to women’s access to abortion care, according to a recent study¹ published in Reproductive Health.

Health systems worldwide have been negatively impacted by COVID-19, with increased burden because of a lack of funding, poor financing, inadequate human and technical resources, and strict health policymaking. Reproductive services including maternity care, sexual health, and family planning have also been affected.

Complications from COVID-19 in mothers increased the need for reproductive care, but fear, stigma, misinformation, and socioeconomic factors led to a reduction in reproductive care. This increased the risk of women facing complications or mortality during pregnancy.

Investigators estimated a 10% reduction in reproductive services could lead to 28,000 additional maternal deaths, over 3.3 million unsafe abortions, and 15.4 million unintended pregnancies. About 4.7% to 13.2% of maternal deaths are associated with unsafe abortions annually.

Remote counseling to take medications to avoid abortions at home was allowed in some countries during the COVID-19 pandemic. This makes telemedicine a potential remedy for strained abortion services.

To determine the impact COVID-19 had on abortion care, investigators conducted a systematic review. Relevant studies were identified through searches of online databases including PubMed, Web of Science, and Scopus. Key words used included abortion, miscarriage, feticide, SARS-CoV-2, coronavirus, and COVID-19.

Investigating abortion services during the COVID-19 pandemic and being published from the start of the pandemic to August 2021 were inclusion criteria for the review. Exclusion criteria included being a non-original article, not having obtainable full texts, and not being an English language study.

Articles were organized using the EndNote software, then screened by 2 independent researchers. Extracted variables included the year, first author, study country, number of participants, type of evidence, age, abortion services, maternal outcome, and other findings. Outcomes were extracted by 3 independent researchers.

The New Castle-Ottawa Scale was used for quality assessment. Two independent researchers performed quality assessment, with a third consulted during disagreements.

There were 17 articles included in the final analysis. The results of these studies indicated an increase in requests for medication abortion through telemedicine and self-managed medication abortion during the COVID-19 pandemic.

An overall decrease was seen in abortion requests and procedures in abortion centers, with the most severe lockdowns associated with the most significant decreases in requests and procedures. A 32% reduction in visits to abortion clinics was reported. In areas prohibiting abortion, this reduction increased by another 23%.

Reported reasons for choosing telemedicine abortion included lockdowns, fear of COVID-19, and travel restrictions. Telemedicine abortion was found to be safe, effective, acceptable, and satisfying for women.

In one study, 38.3% of patients chose telemedicine abortion for privacy, 46.2% for secrecy, and 34.9% for comfort. Access, comfort, flexibility, and ongoing telephone support led to improved quality of abortion care in telemedicine. Complications included bleeding, pain, and need for blood transfusions.

Challenges in abortion clinics because of the COVID-19 pandemic included changes in healthcare providers’ work style, increased costs, and reduced revenue. Investigators concluded abortion laws must be revised to reduce the number of unsafe abortions and associated complications.

This article originally appeared in Contemporary OB/GYN.

Reference

1. Qaderi K, Khodavirdilou R, Kalhor M, et al.Abortion services during the COVID-19 pandemic: a systematic review. Reprod Health. 2023;20(1):61. doi:10.1186/s12978-023-01582-3