Changes to medication abortion clinical practices in response to the COVID-19 pandemic

Abstract

Objectives: To document medication abortion clinical practice changes adopted by providers in response to the COVID-19 pandemic. Study design: Longitudinal descriptive study, comprised of three online surveys conducted between April to December, 2020. We recruited sites from email lists of national abortion and family planning organizations. Results: Seventy-four sites opted to participate. We analyzed 55/74 sites (74%) that provided medication abortion and completed all three surveys. The total number of abortion encounters reported by the sites remained consistent throughout the study period, though medication abortion encounters increased while first-trimester aspiration abortion encounters decreased. In response to the COVID-19 pandemic, sites reduced the number of in-person visits associated with medication abortion and confirmation of successful termination. In February 2020, considered prepandemic, 39/55 sites (71%) required 2 or more patient visits for a medication abortion. By April 2020, 19/55 sites (35%) reported reducing the total number of in-person visits associated with a medication abortion. As of October 2020, 37 sites indicated newly adopting a practice of offering medication abortion follow-up with no in-person visits. Conclusions: Sites quickly adopted protocols incorporating practices that are well-supported in the literature, including forgoing Rh-testing and pre-abortion ultrasound in some circumstances and relying on patient report of symptoms or home pregnancy tests to confirm successful completion of medication abortion. Importantly, these practices reduce face-to-face interactions and the opportunity for virus transmission. Sustaining these changes even after the public health crisis is over may increase patient access to abortion, and these impacts should be evaluated in future research. Implications statement: Medication abortion serves a critical function in maintaining access to abortion when there are limitations to in-person clinic visits. Sites throughout the country successfully and quickly adopted protocols that reduced visits associated with the abortion, reducing in-person screenings, relying on telehealth, and implementing remote follow-up.

Impact of COVID-19 on abortion method under ten weeks gestational age in Southern California

“…Telehealth was not available, but if offered there would have likely been an increase in medication abortions. There was a 27% increase in the rate of requests for medication abortion at home within the first month of the pandemic across the United States, with larger increases in states with more abortion restrictions 11 . In the United Kingdom, research during the pandemic found no difference between telemedicine abortion and traditional in-person care in terms of effectiveness or adverse events 12 .…”

Comparison of Pregnancy Preferences Preceding vs Year 1 of the COVID-19 Pandemic

“…Research has documented substantial constraints in accessing contraceptive and abortion care early in the pandemic, 4 , 5 , 29 , 30 , 31 , 32 followed by implementation of novel approaches to expand access to care via telehealth, mail order, and pharmacies. 33 , 34 Given that social and economic disruptive events can cause population-level increases in people’s desire to prevent or postpone pregnancy, continued implementation and evaluation of these expanded care models will be important to attain reproductive autonomy during future disruptions.…”

The association of U.S. state-level abortion restrictions with medication abortion service delivery innovations during the early COVID-19 pandemic

“…1 ). We then ranked states into quartiles, categorizing each state as having low (0-4 points), medium (5)(6)(7)(8)(9)(10)(11)(12), high (13)(14)(15)(16)(17), or extreme (18-20) abortion restrictions (Supplemental Table 1). To separately estimate the association of global abortion hostility from the effect of laws that specifically prohibit care innovations such as no-exam visits and telemedicine, we created a separate binary variable to indicate if state-level restrictions specifically mandated a visit for medication abortion care by requiring either (1) an ultrasound or (2) in-person dispensing of mifepristone as a state law, in addition to the FDA requirement.…”