An exploratory study of COVID‐19‐related changes in abortion service availability and use in Washington, DC, Maryland, and Virginia

Abstract

Objectives This exploratory study aimed to assess COVID‐19‐related changes in abortion service availability and use in Washington, DC, Maryland, and Virginia. Design Data came from a convenience sample of eight abortion clinics in this region. We implemented a cross‐sectional survey and collected retrospective aggregate monthly abortion data overall and by facility type, abortion type, and patient characteristics for March 2019–August 2020. We evaluated changes in the distribution of the total number of patients for March–August in 2019 compared to March–August 2020. We also conducted segmented regression analyses and produced scatter plots of monthly abortion patients overall and by facility type, abortion type, and patient characteristics, with separate fitted regression lines from the segmented regression models for the pre‐ and during‐COVID‐19 periods. Results Five clinics reported a reduced number of appointments early in the pandemic while four reported increased call volume. There were declines in the monthly abortion trend at hospital‐based clinics at the outset of the pandemic. Monthly number of medication abortions increased from March 2020 through August 2020 compared to pre‐COVID‐19 trends while instrumentation abortions 11 up to 19 weeks decreased. The share of abortions to Black individuals increased during the early phase of the pandemic, as did the monthly trend in abortions among this group. We also saw changes in payment type, with declines in patients paying out‐of‐pocket. Conclusions Results revealed differences in abortion services, numbers, and types during the early stages of the COVID‐19 pandemic in Washington, DC, Maryland, and Virginia.

“I'm going to be forced to have a baby”: A study of COVID‐19 abortion experiences on Reddit

“…Despite abortion's legality prior to the COVID‐19 pandemic, numerous barriers already constrained abortion care in the US: unaffordable out‐of‐pocket procedural costs due to insurance coverage prohibitions, scarcity of abortion providers, difficulty finding transportation to clinics in distant locations, internalized and externalized stigma, and legislative restrictions requiring mandatory waiting periods and other delays in care 11,23,24 . Our study adds to a growing body of literature documenting the broad impacts of COVID‐19 on people trying to seek abortion services 1,4,10,25–29 . Findings from this study document that the COVID‐19 pandemic both amplified pre‐existing obstacles to abortion care and added new challenges.…”

“…11,23,24 Our study adds to a growing body of literature documenting the broad impacts of COVID-19 on people trying to seek abortion services. 1,4,10,[25][26][27][28][29] Findings from this study document that the COVID-19 pandemic both amplified pre-existing obstacles to abortion care and added new challenges. Research has demonstrated system-level abortion clinic closures and protocol modifications occurred during the early phase of the COVID-19 pandemic.…”

“…Our final data set contained 168 posts spanning from March 20, 2020 until April 13, 2020. Each day garnered an average of 22 posts (range [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], and the number of posts gradually increased over the 4 weeks, concluding on April 13, 2020. The included posts averaged of 302 words, roughly half a single-spaced page, with a range of 17 words to 5119 words (a many-paragraph story).…”

COVID‐19 and abortion in the Ohio River Valley: A case study of Kentucky, Ohio, and West Virginia

“…Our findings of increased use of medication abortion during the pandemic echo those of other studies. [12][13][14][15][16][56][57][58] Notably, this shift in method is not exclusive to states that restricted abortion during the pandemic, suggesting that the additional hyper-surveillance and regulation of facilities in states like Kentucky, Ohio, and West Virginia was likely not a singular driving factor in this shift to increased medication abortion use. Rather, facilities in these states adapted their service delivery in part based on public health guidance.…”

“…In Texas, which banned instrumentation abortions under state emergency COVID orders, there was increased use of medication abortion in the first trimester 14 . Facilities in Maryland, Virginia, the District of Columbia, 15 and Southern California 16 also experienced increases in medication abortion provision during the pandemic, despite a lack of state orders requiring them to do so. Contrastingly, facilities in Northern California 17 saw an increase in the number of instrumentation abortions during this same period, suggesting variation within individual state contexts.…”