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Smith MH, Broscoe M, Chakraborty P, Hill J, Hood R, McGowan M, Bessett D, Norris AH. COVID-19 and abortion in the Ohio River Valley: A case study of Kentucky, Ohio, and West Virginia. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:178-191. [PMID: 37571959 DOI: 10.1363/psrh.12244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
INTRODUCTION During early stages of COVID-19 in the United States, government representatives in Kentucky, Ohio, and West Virginia restricted or threatened to restrict abortion care under elective surgery bans. We examined how abortion utilization changed in these states. METHODOLOGY We examined COVID-19 abortion-related state policies implemented in March and April 2020 using publicly available sources. We analyzed data on abortions by method and gestation and experiences of facility staff, using a survey of 14 facilities. We assessed abortions that took place in February-June 2020 and February-June 2021. RESULTS In February-June 2020 the monthly average abortion count was 1916; 863 (45%) were medication abortions and 229 (12%) were ≥14 weeks gestation. Of 1959 abortions performed across all three states in April 2020, 1319 (67%) were medication abortions and 231 (12%) were ≥14 weeks gestation. The shift toward medication abortion that took place in April 2020 was not observed in April 2021. Although the total abortion count in the three-state region remained steady, West Virginia had the greatest decline in total abortions, Ohio experienced a shift from instrumentation to medication abortions, and Kentucky saw little change. Staff reported increased stress from concerns over health and safety and increased scrutiny by the state and anti-abortion protesters. DISCUSSION Although abortion provision continued in this region, policy changes restricting abortion in Ohio and West Virginia resulted in a decrease in first trimester instrumentation abortions, an overall shift toward medication abortion care, and an increase in stress among facility staff during the early phase of COVID-19.
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Affiliation(s)
- Mikaela H Smith
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, USA
| | - Molly Broscoe
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessie Hill
- Case Western Reserve University School of Law, Cleveland, Ohio, USA
| | - Robert Hood
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michelle McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, Ohio, USA
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alison H Norris
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, USA
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Wirken B, Barten DG, De Cauwer H, Mortelmans L, Tin D, Ciottone G. Terrorist Attacks against Health Care Targets that Provide Abortion Services. Prehosp Disaster Med 2023:1-6. [PMID: 36942568 DOI: 10.1017/s1049023x23000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Terrorist attacks against hospitals and health care providers have disproportionally increased during the last decades. A significant proportion of these attacks targeted abortion clinics and abortion providers. In the light of the overturning of Roe v. Wade in 2022, an increase of anti-abortion terrorist attacks is anticipated. Therefore, it becomes imperative to gain further insight into the risk and characteristics of past terrorist attacks. This study aimed to review terrorist attacks against health care targets providing abortion services from 1970 through 2020. METHODS Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database functions for all terrorist attacks against abortion health care providers from January 1, 1970 - December 31, 2020. Temporal factors, location, attack and weapon type, and number of casualties or hostages were analyzed using descriptive statistics. RESULTS In total, 262 terrorist attacks were identified in five different countries. The majority (96.6%) occurred in the United States, with the highest counts during the last 20 years of the 20th century. Facility and infrastructure attacks were the most common attack types, followed by bombings and explosions. The attacks resulted in 34 injuries and nine fatalities. Kidnapping took place in three incidents. Of all successful attacks, 96.9% resulted in property damage. CONCLUSION Abortion-related health care facilities and providers have repeatedly been the target of terrorists over the past decades. Nearly all of these attacks took place in the United States, with the highest counts during the last 20 years of the 20th century.
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Affiliation(s)
- Bart Wirken
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Harald De Cauwer
- Department of Neurology, Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Luc Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium; REGEDIM, Free University Brussels, Brussels, Belgium; Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
| | - Derrick Tin
- Faculty, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA
| | - Gregory Ciottone
- Director, BIDMC Disaster Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
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Examining Healthcare Professionals’ Telehealth Usability before and during COVID-19 in Saudi Arabia: A Cross-Sectional Study. NURSING REPORTS 2022; 12:648-654. [PMID: 36135983 PMCID: PMC9504350 DOI: 10.3390/nursrep12030064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/21/2022] Open
Abstract
COVID-19 has placed substantial stress on healthcare providers in Saudi Arabia as they struggle to avoid contracting the virus, provide continued care for their patients, and protect their own families at home from possible exposure. The demand for care has increased due to the need to treat COVID-19. This pandemic has created a surge in the need for care in select healthcare delivery specialties, forcing other nonurgent or elective care to halt or transition to telehealth. This study provides a timely description of how COVID-19 affected employment, telehealth usage, and interprofessional collaboration. The STROBE checklist was used. We developed a cross-sectional online survey design that is rooted and grounded in the Technology Acceptance Model (TAM). The TAM model allows us to identify characteristics that affect the use of telehealth technologies. The survey was deployed in November 2021 to local healthcare providers in Saudi Arabia. There were 66 individuals in the final sample. Both interprofessional satisfaction on frequency and quality were positively correlated with the frequency of interactions. The odds for satisfaction of frequency and quality were about 12 times (OR = 12.27) and 8 times 110 (OR = 8.24) more, respectively, for the participants with more than three times of interaction than the participants with no interaction at all. We also found that change in telehealth usage during the pandemic was positively associated with the Telehealth Usability Questionnaire (TUQ) scores. The estimated score for the participants who reported an increase in telehealth usage was 5.37, while the scores were lower for the participants reporting ‘no change’ and ‘decreased usage’. Additional training on telehealth use and integration to improve interprofessionalism is needed.
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Hukku S, Ménard A, Kemzang J, Hastings E, Foster AM. "I just was really scared, because it's already such an uncertain time": Exploring women's abortion experiences during the COVID-19 pandemic in Canada. Contraception 2022; 110:48-55. [PMID: 35123980 PMCID: PMC8812083 DOI: 10.1016/j.contraception.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Travel restrictions, physical distancing and quarantine requirements, lockdowns, and stay-at-home orders due to COVID-19 have impacted abortion services across Canada. We aimed to explore the decision-making and care experiences of those who obtained abortion services during the COVID-19 pandemic and understand recent abortion patients' perspectives on demedicalized models of medication abortion service delivery. STUDY DESIGN We conducted 23 semi-structured, in-depth interviews with women across Canada who obtained abortion care after March 15, 2020. We audio-recorded and transcribed the telephone/Skype/Zoom interviews and managed our data with ATLAS.ti. We analyzed the English-language interviews for content and themes using inductive and deductive techniques. RESULTS The COVID-19 pandemic, and the associated economic and social support uncertainties, factored into many of our participants' decisions to obtain an abortion. Participants expressed relief and gratitude for being able to secure abortion care during the pandemic. Although women in our study reflected positively on their abortion care experiences, many felt that service delivery changes initiated because of the public health emergency exacerbated pre-COVID-19 barriers to care and contributed to feelings of loneliness and isolation. Our participants expressed considerable enthusiasm for demedicalized models of medication abortion care, including telemedicine services and behind-the-counter availability of mifepristone/misoprostol. CONCLUSIONS For our participants, abortion care constituted an essential health service. Our findings demonstrate the importance of continuing to provide access to safe, effective, and timely abortion care during public health emergencies. Exploring additional models of demedicalized medication abortion service delivery to address persistent access barriers in Canada is warranted. IMPLICATIONS Policymakers and clinicians should consider patient experiences as well as clinical evidence when considering regulatory changes to facilitate access to abortion care during public health emergencies. Identifying a multitude of ways to offer a full range of abortion services, including demedicalized models of medication abortion care, has the potential to meet significant needs in the COVID-19 era and beyond. The COVID pandemic highlights the need for demedicalized models, not only for the sake of those seeking abortion care but also to ease the burden on medical professionals during public health emergencies.
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Affiliation(s)
- Srishti Hukku
- Faculty of Health Sciences, University of Ottawa, ON, Canada
| | | | - Julia Kemzang
- Faculty of Health Sciences, University of Ottawa, ON, Canada
| | - Erin Hastings
- Faculty of Health Sciences, University of Ottawa, ON, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, ON, Canada; Institute of Population Health, University of Ottawa, ON Canada.
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Pharmacological Abortion in a Pandemic: An Italian Medico-Legal Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212043. [PMID: 34831795 PMCID: PMC8619535 DOI: 10.3390/ijerph182212043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
The limitations caused by the spread of the SARS-CoV2 virus have had repercussions on the voluntary termination of pregnancy. During the pandemic, Italy issued updated guidelines regarding voluntary termination of pregnancy by means of mifepristone and prostaglandin. This included news concerning the time limit and location in which this procedure could be accessed: updates partially recognize women’s needs, and they are into line with the European parliament’s recent exhortations. However, these updates do not change the previously provided responsibilities that lie with doctors. This article aimed to compare regulations concerning medical abortion in Italy and other countries, with a focus on recent Italian updates in the context of pandemic.
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Influence of the Coronavirus Disease 2019 (COVID-19) Pandemic on Delays in and Barriers to Abortion. Obstet Gynecol 2021; 138:805-808. [PMID: 34619741 PMCID: PMC8522335 DOI: 10.1097/aog.0000000000004569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is associated with delays in and barriers to accessing abortion, which are associated with higher gestational ages at the time of abortion.
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Ennis M, Wahl K, Jeong D, Knight K, Renner R, Munro S, Dunn S, Guilbert E, Norman WV. The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic. Fam Pract 2021; 38:i30-i36. [PMID: 34448482 PMCID: PMC8414916 DOI: 10.1093/fampra/cmab083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic. OBJECTIVE We sought to characterize the experiences of abortion health care professionals in Canada during the COVID-19 pandemic and the impact of the pandemic response on abortion services. METHODS We conducted a sequential mixed methods study between July 2020 and January 2021. We invited physicians, nurse practitioners and administrators to participate in a cross-sectional survey containing an open-ended question about the impact of the pandemic response on abortion care. We employed an inductive codebook thematic analysis, which informed the development of a second, primarily quantitative survey. RESULTS Our initial survey had 307 respondents and our second had 78. Fifty-three percent were family physicians. Our first survey found respondents considered abortion access essential. We identified three key topicss: access to abortion care was often maintained despite pandemic-related challenges (e.g. difficulty obtaining tests, additional costs); change of practice to low-touch medication abortion care and provider perceptions of patient experience, including shifting demand, telemedicine acceptability and increased rural access. The second survey indicated uptake of telemedicine medication abortion among 89% of participants except in Quebec, where regulations meant procedures were nearly exclusively surgical. Restrictions did not delay care according to 76% of participants. CONCLUSIONS Canadian health care professionals report their facilities deemed abortion an essential service. Provinces and territories, except Quebec, described a robust pandemic transition to telemedicine to ensure access to services. PODCAST An accompanying podcast is available in the Supplementary Data, in which the authors Dr Madeleine Ennis and Kate Wahl discuss their research on how family planning care and access to abortion services have changed during the COVID-19 pandemic.
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Affiliation(s)
- Madeleine Ennis
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Kate Wahl
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Dahn Jeong
- The School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kira Knight
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Regina Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Edith Guilbert
- Department of Obstetrics and Gynaecology, Laval University, Quebec City, QC, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, Canada.,Department of Public Health, Environments and Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Roberts SCM, Berglas NF, Schroeder R, Lingwall M, Grossman D, White K. Disruptions to Abortion Care in Louisiana During Early Months of the COVID-19 Pandemic. Am J Public Health 2021; 111:1504-1512. [PMID: 34185578 PMCID: PMC8489634 DOI: 10.2105/ajph.2021.306284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine changes in abortions in Louisiana before and after the COVID-19 pandemic onset and assess whether variations in abortion service availability during this time might explain observed changes. Methods. We collected monthly service data from abortion clinics in Louisiana and neighboring states among Louisiana residents (January 2018‒May 2020) and assessed changes in abortions following pandemic onset. We conducted mystery client calls to 30 abortion clinics in Louisiana and neighboring states (April‒July 2020) and examined the percentage of open and scheduling clinics and median waits. Results. The number of abortions per month among Louisiana residents in Louisiana clinics decreased 31% (incidence rate ratio = 0.69; 95% confidence interval [CI] = 0.59, 0.79) from before to after pandemic onset, while the odds of having a second-trimester abortion increased (adjusted odds ratio [AOR] = 1.91; 95% CI = 1.10, 3.33). The decrease was not offset by an increase in out-of-state abortions. In Louisiana, only 1 or 2 (of 3) clinics were open (with a median wait > 2 weeks) through early May. Conclusions. The COVID-19 pandemic onset was associated with a significant decrease in the number of abortions and increase in the proportion of abortions provided in the second trimester among Louisiana residents. These changes followed service disruptions.
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Affiliation(s)
- Sarah C M Roberts
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Nancy F Berglas
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Rosalyn Schroeder
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Mary Lingwall
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Daniel Grossman
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
| | - Kari White
- Sarah C. M. Roberts, Nancy F. Berglas, Rosalyn Schroeder, Mary Lingwall, and Daniel Grossman are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland. Kari White is with the Texas Policy Evaluation Project, Population Research Center, University of Texas at Austin
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Hicks-Roof KK, Xu J, Zeglin RJ, Bailey CE, Hamadi HY, Osborne R. Covid-19 Impacts on Florida's Healthcare Professionals. Hosp Top 2021; 100:112-122. [PMID: 34028344 DOI: 10.1080/00185868.2021.1927277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study described how COVID-19 impacted employment, telehealth usage, and interprofessional collaboration. A cross-sectional survey was deployed in June 2020 to healthcare professionals in Florida. Job status was uniquely separated by profession, with more nurses and medical doctors reported having no effect, and more mental health counselors transitioned to telehealth. Over a third of rehabilitation providers reported being furloughed. Over forty percent of providers had no training in telehealth, yet 33.1% reported an increase in usage. Interprofessional interactions are lower across professions during the pandemic, compared with before. This study shows the need for additional training on telehealth and interprofessional collaboration.
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Affiliation(s)
- Kristen K Hicks-Roof
- Department of Nutrition & Dietetics, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Jing Xu
- Department of Health Administration, University of North Florida, Jacksonville, FL, USA
| | - Robert J Zeglin
- Department of Public Health, University of North Florida, Jacksonville, FL, USA
| | - Chloe E Bailey
- Department of Health Administration, University of North Florida, Jacksonville, FL, USA
| | - Hanadi Y Hamadi
- Department of Health Administration, University of North Florida, Jacksonville, FL, USA
| | - Raine Osborne
- Brooks Rehabilitation, Jacksonville, FL, USA.,Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, FL, USA
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Roberts SC, Schroeder R, Joffe C. COVID-19 and Independent Abortion Providers: Findings from a Rapid-Response Survey. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:217-225. [PMID: 33289197 PMCID: PMC7753746 DOI: 10.1363/psrh.12163] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 05/04/2023]
Abstract
CONTEXT The ways in which the COVID-19 pandemic has affected abortion providers and abortion care, and the strategies clinics are adopting to navigate the pandemic, have not been well documented. METHODS In April-May 2020, representatives from 103 independent abortion clinics (i.e., those not affiliated with Planned Parenthood) completed a survey that included close-ended questions about how the pandemic, the public health response, and designations of abortion as a nonessential service had affected their clinic, as well as open-ended questions about the pandemic's impact. Analyses were primarily descriptive but included an exploration of regional variation. RESULTS All U.S. regions were represented in the sample. At 51% of clinics, clinicians or staff had been unable to work because of the pandemic or public health responses. Temporary closures were more common among clinics in the South (35%) and Midwest (21%) than in the Northeast and West (5% each). More than half of clinics had canceled or postponed nonabortion services (e.g., general gynecologic care); cancelation or postponement of abortion services was less common (25-38%, depending on type) and again especially prevalent in the South and Midwest. Respondents reported the pandemic had had numerous effects on their clinics, including disrupting their workforce, clinic flow and work practices; increasing expenses; and reducing revenues. State laws (including designations of abortion as nonessential) had exacerbated these difficulties. CONCLUSIONS Although independent abortion clinics have faced considerable challenges from the pandemic, most continued to provide abortion care. Despite this resiliency, additional support may be needed to ensure sustainability of these clinics.
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Affiliation(s)
- Sarah C.M. Roberts
- Advancing New Standards in Reproductive HealthUniversity of CaliforniaSan Francisco
| | - Rosalyn Schroeder
- Bixby Center for Global Reproductive HealthUniversity of CaliforniaSan Francisco
| | - Carole Joffe
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of CaliforniaSan Francisco
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Upadhyay UD, Schroeder R, Roberts SC. Adoption of no-test and telehealth medication abortion care among independent abortion providers in response to COVID-19. Contracept X 2020; 2:100049. [PMID: 33305255 PMCID: PMC7718446 DOI: 10.1016/j.conx.2020.100049] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/07/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Access to abortion care in the United States (US) is restricted by numerous logistical and financial barriers, which have been further intensified by the COVID-19 pandemic. We sought to understand the ways in which COVID-19 prompted changes in clinical practices in abortion care among independent abortion clinics. STUDY DESIGN We surveyed independent US abortion clinics and documented changes in practice regarding the provision of abortion since March 1, 2020. RESULTS Among about 153 independent clinics invited, 100 clinics contributed relevant data and were included in the analytic sample. A total of 87% reported changes in protocols in response to the COVID-19 pandemic. Reported changes included moving to telehealth (phone or video) for follow-up (71%), starting or increasing telehealth for patient consultations and screening (41%), reducing Rh testing (43%) and other tests (42%), and omitting the preabortion ultrasound (15%). A total of 20% reported allowing quick pickup of medication abortion pills, and 4% began mailing medications directly to patients after a telehealth consultation. Clinical practice changes were reported throughout all regions of the US, but facilities in the Northeast (73%) were more likely to report starting or increasing telehealth than facilities in the South (23%, p < .001). CONCLUSION The COVID-19 pandemic accelerated use of telehealth among independent abortion clinics, but many clinics, particularly those in the South, have been unable to make these changes. Other practices such as reducing preabortion ultrasounds were less common in all regions despite clinical guidelines and evidence supporting such changes in practice and positive benefits for public health and patient-centered care. IMPLICATIONS The COVID-19 pandemic has created a window of opportunity to remove barriers to abortion, including expanding telehealth and reducing preabortion tests. Clinics can strive for a culture shift towards simplifying the provision of medication abortion and routinely avoiding preabortion tests and in-person visits. Such changes in practice could have positive benefits for public health and patient-centered care.
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Affiliation(s)
- Ushma D. Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Dept. of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health (ANSIRH), Dept. of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
| | - Sarah C.M. Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Dept. of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612
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