"In some clinics, they said it's elective, and then they would refuse": A Mixed-Methods Study on the impact of the COVID-19 pandemic on access to abortion services in Germany.

OBJECTIVE: The World Health Organization recognizes abortion as essential health care and has encouraged governments to ensure access to abortion services throughout the COVID-19 pandemic. However, the threat of infection combined with government responses to COVID-19 have impacted access to abortion services globally. This study explores access to abortion in Germany during the pandemic. METHODS: This study used a mixed-methods design. An analysis of data collected by Women on Web (WoW) was carried out to assess women's reasons for choosing telemedicine abortion outside the formal health system in Germany during the pandemic. Descriptive statistics were generated for 2057 requests for telemedicine abortion received by WoW between March 2020-March 2021. Semi-structured interviews were conducted with eight healthcare professionals involved in the provision of abortion services to explore how they perceive of women's access to abortion services in Germany during the pandemic. RESULTS: The quantitative analysis found that preferences and needs for privacy (47.3%), secrecy (44.4%) and comfort (43.9%) were the most common reasons for choosing telemedicine abortion. COVID-19 was another important reason (38.8%). The thematic analysis of the interviews was organized into two overarching themes: service provision, and axes of difference. CONCLUSIONS: The pandemic affected the provision of abortion services as well as the circumstances of women seeking abortion. The main barriers to access were financial constraints, privacy issues, and lack of abortion providers. Throughout the pandemic, accessing abortion services was more difficult for many women in Germany, especially women experiencing multiple and overlapping forms of discrimination.

How the pandemic is transforming abortion access: CMAJ

The COVID-19 pandemic has been a catalyst for more accessible abortion care in Canada, even as other countries report increasing barriers to the service. But according to a study of more than 300 Canadian abortion providers published in Family Practice, fewer than one in five had any experience providing medical abortions by telemedicine before the pandemic. By Jan 2021, however, nearly nine in 10 reported providing some or all aspects of abortion care virtually--from counseling and prescribing to follow up and emergency care. According to Madeleine Ennis and coauthors, most providers reported maintaining or increasing access to abortion while making a "seamless switch" to virtual care, except in Quebec, where restrictions on mifepristone remained a barrier.