Abortion services during the COVID-19 pandemic: a systematic review
Tóm tắt
Evidence suggests that COVID-19 may impair access to sexual and reproductive health services and safe abortion. The purpose of this systematic review was investigating the changes of abortion services in the COVID-19 pandemic era. We searched PubMed, Web of Science and Scopus for relevant studies published as of August 2021, using relevant keywords. RCT and non-original studies were excluded from the analysis and 17 studies of 151 included in our review. Requests to access medication abortion by telemedicine and demand for self-managed abortion were the main findings of identified studies. Women requested an abortion earlier in their pregnancy, and were satisfied with tele-abortion care due to its flexibility, and ongoing telephone support. Presenting telemedicine services without ultrasound has also been reported. Visits to clinics were reduced based on the severity of the restrictions, and abortion clinics had less revenue, more costs, and more changes in the work style of their healthcare providers. Telemedicine was reported safe, effective, acceptable, and empowering for women. Reasons for using tele-abortion were privacy, secrecy, comfort, using modern contraception, employing of women, distance from clinics, travel restrictions, lockdowns, fear of COVID-19, and political reasons (abortion prohibition). Complications of women using tele-abortion were pain, lack of psychological support, bleeding, and need to blood transfusions. The results of this study showed that using telemedicine and teleconsultations for medical abortion in the pandemic conditions may be extended after pandemic. Findings can be used by reproductive healthcare providers and policy makers to address the complications of abortion services. Trail registration This study is registered in PROSPERO with number
CRD42021279042
COVID-19 pandemic shocks the international community, especially health policymakers around the world. The most important consequence of this outbreak has been direct and indirect impacts on health service provisions in all parts of the health system, including sexual and reproductive health services. We reviewed numerous studies investigating healthcare related to abortion in the pandemic era that showed women had more requests to access medical abortion, more than surgical. They preferred self-managed abortion process by telemedicine. Presenting telemedicine services without ultrasound has also been reported. Visits to clinics were reduced, and this decrease was reported based on the severity of the restrictions. Abortion clinics had reduced revenue, increased costs, and changed work style of their healthcare providers. Reasons for using telemedicine were fear of COVID-19, travel restrictions, lockdowns, more privacy, secrecy, and comfort. Telemedicine was reported safe, effective, acceptable, satisfying, and empowering for women. Maternal complications using tele-abortion were pain, bleeding, and need to blood transfusions. These findings can be used by policy makers and reproductive healthcare providers to address the complications of abortion management.
Tài liệu tham khảo
World Health Organization. COVID-19 related mortality and morbidity among healthcare providers—based on information as at 14 February 2021. Brazzaville: Regional Office for Africa; 2021.
World Health Organization. WHO Coronavirus dashboard. 2021. https://covid19.who.int/. Accessed 13 Jan 2022.
Armocida B, et al. The Italian health system and the COVID-19 challenge. Lancet Public health. 2020;5(5):e253–e253.
Krubiner CB, Keller JM, Kaufman J. Balancing the COVID-19 response with wider health needs: key decision-making considerations for low-and middle-income countries. CGDev. 2020;8.
McDonnell S, et al. The impact of the Covid-19 pandemic on maternity services: a review of maternal and neonatal outcomes before, during and after the pandemic. Eur J Obstet Gynecol Reprod Biol. 2020;255:172–6.
Townsend R, et al. Global changes in maternity care provision during the COVID-19 pandemic: a systematic review and meta-analysis. E Clin Med. 2021;37:100947.
Roberton T, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020;8(7):e901–8.
Riley T, et al. Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries. Int Perspect Sex Reprod Health. 2020;46:73–6.
Adelekan B, et al. Effect of COVID-19 pandemic on provision of sexual and reproductive health services in primary health facilities in Nigeria: a cross-sectional study. Reprod Health. 2021;18(1):166.
Krishna UR. Reproductive health during the COVID-19 pandemic. J Obstet Gynaecol India. 2021. https://doi.org/10.1007/s13224-021-01546-2.
Say L, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.
Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG. 2016;123(9):1489–98.
Vlassoff M, Shearer J, Walker D, Lucas H, et al. Economic impact of unsafe abortion-related morbidity and mortality: evidence and estimation challenges. Brighton: Institute of Development Studies; 2008. p. 94.
Todd-Gher J, Shah PK. Abortion in the context of COVID-19: a human rights imperative. Sex Reprod Health Matters. 2020;28(1):1758394.
Wang Y, Yang Q. Post abortion care and management after induced abortion during the COVID-19 pandemic: a Chinese expert consensus. Adv Ther. 2021;38(2):1011–23.
Foschi N, et al. Urological safety and COVID-19 vaccinations. Vaccines. 2022;10(11):1887.
Aryal S, Nepal S, Ballav Pant S. Safe abortion services during the COVID -19 pandemic: a cross-sectional study from a tertiary center in Nepal. F1000Research. 2021;10:112.
Andersen M, Bryan S, Slusky D. COVID-19 surgical abortion restriction did not reduce visits to abortion clinics. SSRN J. 2020. https://doi.org/10.2139/ssrn.3726434.
Marquez-Padilla F, Saavedra B. The unintended effects of the COVID-19 pandemic and stay-at-home orders on abortions. J Popul Econ. 2022;35(1):269–305.
Boydell N, et al. Women’s experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID-19) pandemic: a qualitative evaluation. BJOG. 2021. https://doi.org/10.1111/1471-0528.16813.
LaRoche KJ, et al. Attitudes of US adults toward using telemedicine to prescribe medication abortion during COVID-19: a mixed methods study. Contraception. 2021;104(1):104–10.
Atay H, et al. Why women choose at-home abortion via teleconsultation in France: drivers of telemedicine abortion during and beyond the COVID-19 pandemic. BMJ Sex Reprod Health. 2021. https://doi.org/10.1136/bmjsrh-2021-201176.
Kerestes C, et al. Provision of medication abortion in Hawai’i during COVID-19: practical experience with multiple care delivery models. Contraception. 2021;104(1):49–53.
Gibelin K, et al. COVID-19 impact in abortions’ practice, a regional French evaluation. J Gynecol Obstet Human Reprod. 2021;50(5):102038.
De Kort L, Wouters E, van de Velde S. Obstacles and opportunities: a qualitative study of the experiences of abortion centre staff with abortion care during the first COVID-19 lockdown in Flanders, Belgium. Sex Reprod Health Matters. 2021;29(1):180.
Chong ER, et al. Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic. Contraception. 2021;104(1):43–8.
Aiken AR, Starling JE, Gomperts R. Factors associated with use of an online telemedicine service to access self-managed medical abortion in the US. JAMA Netw Open. 2021;4(5):e2111852–e2111852.
Aiken AR, et al. Demand for self-managed online telemedicine abortion in the United States during the coronavirus disease 2019 (COVID-19) pandemic. Obstet Gynecol. 2020;136(4):835.
Romanis EC, Parsons JA. Legal and policy responses to the delivery of abortion care during COVID-19. Int J Gynecol Obstet. 2020;151(3):479–86.
Aiken AR, et al. Demand for self-managed online telemedicine abortion in eight European countries during the COVID-19 pandemic: a regression discontinuity analysis. BMJ Sex Reprod Health. 2021. https://doi.org/10.1136/bmjsrh-2020-200880.
De Kort L, et al. Abortion care in a pandemic: an analysis of the number and social profile of people requesting and receiving abortion care during the first COVID-19 lockdown (March 16 to June 14, 2020) in Flanders, Belgium. Arch Public Health. 2021;79(1):140.
Godfrey EM, et al. Family medicine provision of online medication abortion in three US states during COVID-19. Contraception. 2021;104(1):54–60.
Karlin J, et al. Greasing the wheels: the impact of COVID-19 on US physician attitudes and practices regarding medication abortion. Contraception. 2021;104(3):289–95.
Reynolds-Wright JJ, et al. Telemedicine medical abortion at home under 12 weeks’ gestation: a prospective observational cohort study during the COVID-19 pandemic. BMJ Sex Reprod Health. 2021. https://doi.org/10.1136/bmjsrh-2020-200976.
Kaller S, et al. Abortion service availability during the COVID-19 pandemic: results from a national census of abortion facilities in the U.S. Contraception X. 2021;3:100067.
Porter Erlank C, Lord J, Church K. Acceptability of no-test medical abortion provided via telemedicine during Covid-19: analysis of patient-reported outcomes. BMJ Sex Reprod Health. 2021. https://doi.org/10.1136/bmjsrh-2020-200954.
Roberts SCM, Schroeder R, Joffe C. COVID-19 and independent abortion providers: findings from a rapid-response survey. Perspect Sex Reprod Health. 2020;52(4):217–25.
Roberts SCM, et al. Disruptions to abortion care in Louisiana during early months of the COVID-19 pandemic. Am J Public Health. 2021. https://doi.org/10.2105/AJPH.2021.306284.
Bayefsky MJ, Bartz D, Watson KL. Abortion during the Covid-19 pandemic—ensuring access to an essential health service. N Engl J Med. 2020;382(19): e47.
Turret E et al. COVID-19 does not change the right to abortion. Health Aff. 2020; 17.
Center for reproductive rights. Breaking ground 2018: treaty monitoring bodies on reproductive rights. New York: Center for Reproductive Rights; 2018.
CESCR U. General Comment No. 22, para. 49 (a)(c)(e). UN Doc. E/C.12/GC/22. 2016. https://www.escr-net.org/resources/general-comment-no-22-2016-right-sexual-and-reproductive-health.
CESCR, U. General comment No. 14, para. 44. UN Doc. E/C.12/2000/4. 2000. https://www.escr-net.org/resources/general-comment-14.
Hantoushzadeh S, et al. Experiences of health care providers on pregnancy and childbirth care during the COVID-19 pandemic in Iran: a phenomenological study. BMC Pregnancy Childbirth. 2021;21(1):1–9.
Semaan A, et al. Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic. BMJ Glob Health. 2020;5(6): e002967.