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2.
Fam Pract ; 38(Suppl 1): i30-i36, 2021 08 27.
Article in English | MEDLINE | ID: covidwho-1376300

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.


Access to abortion care was challenged by the response to COVID-19. Canada had fewer restrictions on medical abortion than many other countries when the pandemic began. The goal of this study was to describe the experiences of health care practitioners providing abortion in Canada and the impact of the pandemic and the pandemic response measures on abortion services. We conducted two surveys of physicians, nurse practitioners and administrators between July 2020 and January 2021. Most of the health care practitioners who participated reported that medical and surgical abortion care were essential and that, except in the province of Quebec, there was a rapid transition to virtual telemedicine care for first trimester abortions. Several practitioners said that virtual care made abortion more accessible. Other practitioners reported that it was challenging to order certain tests, access operating room facilities or make referrals for late second trimester cases. Practitioners felt that patients had strong fears about COVID-19 exposure and reported that limited contraception access was increasingly a reason for seeking abortion care. The results of the study suggested that abortion was considered essential and that the pandemic instigated a transition to virtual care in all provinces and territories except Quebec.


Subject(s)
Abortion, Induced/statistics & numerical data , Attitude of Health Personnel , COVID-19/epidemiology , Adult , Canada/epidemiology , Cross-Sectional Studies , Female , Health Services Accessibility , Humans , Male , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine
4.
BJOG ; 128(9): 1464-1474, 2021 08.
Article in English | MEDLINE | ID: covidwho-1337350

ABSTRACT

OBJECTIVE: To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine. DESIGN: Cohort analysis. SETTING: The three main abortion providers. POPULATION OR SAMPLE: Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally. METHODS: Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences. MAIN OUTCOME MEASURES: Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability. RESULTS: Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine. CONCLUSIONS: A telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care. TWEETABLE ABSTRACT: Compelling evidence from 52 142 women shows no-test telemedicine abortion is safe, effective and improves care.


Subject(s)
Abortion, Induced/methods , Telemedicine/methods , Abortion, Induced/statistics & numerical data , COVID-19/epidemiology , Case-Control Studies , Cohort Studies , England/epidemiology , Female , Humans , Pandemics , Pregnancy , SARS-CoV-2 , Telemedicine/statistics & numerical data , Ultrasonography, Prenatal/statistics & numerical data
5.
Sex Reprod Health Matters ; 29(1): 1921901, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1226511

ABSTRACT

The COVID-19 pandemic and corresponding measures impacted the organisation of services for abortion on request in Flanders, Belgium. This study describes abortion centre staff's perceptions of the influence of protective measures on abortion consultations and procedures, and aims to identify obstacles and opportunities that arose from this situation. Through the anonymised patient records of one Flemish abortion centre, we compared the number of requests and abortions during the first lockdown (16 March-14 June 2020) with the same period in the five preceding years. Using a phenomenological approach, we documented the procedures and conducted interviews (all inductively coded in Nvivo) with the centre's coordinator, seven psychosocial staff members and three doctors. Though fewer people requested and had an abortion, the pressure on the staff was high due to changed procedures. A substantial change was the substitution of telephone for in-person consultations, which the staff perceived as less suited for discussing worries, contraception counselling, and building trust. The centre remained accessible, but the staff perceived an influence on the emotional reactions of clients. Staff agreed that the lockdown did not negatively influence the abortion procedure itself. However, they felt a negative influence on the level of psychological support they could offer, especially in interactions with clients who were less certain of their choice and clients with whom there was no common language. When the lockdown was relaxed, a triage system was set up to ensure emotionally safe abortion care - as perceived by staff - for all clients.


Subject(s)
Abortion Applicants/statistics & numerical data , Abortion, Induced/statistics & numerical data , Ambulatory Care Facilities/organization & administration , Delivery of Health Care/organization & administration , Health Personnel/psychology , Abortion Applicants/psychology , Belgium/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Female , Humans , Male , Pregnancy , Qualitative Research , SARS-CoV-2
6.
Contraception ; 104(1): 54-60, 2021 07.
Article in English | MEDLINE | ID: covidwho-1210891

ABSTRACT

OBJECTIVE: To examine provision of direct-to-patient medication abortion during COVID-19 by United States family physicians through a clinician-supported, asynchronous online service, Aid Access. STUDY DESIGN: We analyzed data from United States residents in New Jersey, New York, and Washington who requested medication abortion from 3 family physicians using the online service from Aid Access between April and November 2020. This study seeks to examine individual characteristics, motivations, and geographic locations of patients receiving abortion care through the Aid Access platform. RESULTS: Over 7 months, three family physicians using the Aid Access platform provided medication abortion care to 534 residents of New Jersey, New York, and Washington. There were no demographic differences between patients seeking care in these states. A high percentage (85%) were less than 7 weeks gestation at the time of their request for care. The reasons patients chose Aid Access for abortion services were similar regardless of state residence. The majority (71%) of Aid Access users lived in urban areas. Each family physician provided care to most counties in their respective states. Among those who received services in the three states, almost one-quarter (24%) lived in high Social Vulnerability Index (SVI) counties, with roughly one-third living in medium-high SVI counties (33%), followed by another quarter (26%) living in medium-low SVI counties. CONCLUSIONS: Family physicians successfully provided medication abortion in three states using asynchronous online consultations and medications mailed directly to patients. IMPLICATIONS: Primary care patients are requesting direct-to-patient first trimester abortion services online. By providing abortion care online, a single provider can serve the entire state, thus greatly increasing geographic access to medication abortion.


Subject(s)
Abortifacient Agents/therapeutic use , Abortion, Induced/statistics & numerical data , COVID-19 , Delivery of Health Care/methods , Family Practice/methods , Abortion, Induced/psychology , Adolescent , Adult , COVID-19/prevention & control , Drug Prescriptions , Female , Gestational Age , Humans , Internet , Middle Aged , Motivation , New Jersey , New York , Pregnancy , SARS-CoV-2 , Social Stigma , Socioeconomic Factors , Washington , Young Adult
8.
J Gynecol Obstet Hum Reprod ; 50(5): 102038, 2021 May.
Article in English | MEDLINE | ID: covidwho-966762

ABSTRACT

INTRODUCTION: On March 14, 2020, France has entered into stage 3 of the COVID-19 pandemic. The French National Health Agency (Haute Autorité de Santé) has urgently recommended the use of medical abortion at home between 7 and 9 weeks of gestation and telemedicine for medical abortion consultations. The main objective of this study was to assess whether the emergency measures undertaken for the management of abortions during the COVID-19 pandemic led to practice changes, and to obtain practitioners' opinions regarding the continuation of these measures. MATERIAL AND METHODS: This was a retrospective, quantitative, online self-administered survey from August 6, 2020 to October 2, 2020, aimed at health workers performing abortions (midwives, general practitioners, gynecologists obstetricians and medical gynecologists) in the South and Corse regions in France. RESULTS: Among the 124 practitioners included, 59/77 (76.6 %) offered medical abortion at home between 7 and 9 weeks of gestation and 61/89 (68.5 %) of them wished to carry on this practice. 55/123 (44.7 %) practitioners offered telemedicine for medical abortion at home and 71/115 (61.7 %) of them wished to carry on this practice. DISCUSSION: The emergency measures implemented by the the French National Health Agency (Haute Autorité de Santé) for medical abortion are approved and followed by the majority of health workers performing abortions in the South and Corse regions. This measure may be extended out of the COVID-19 epidemic.


Subject(s)
Abortion, Induced/statistics & numerical data , Abortifacient Agents, Nonsteroidal/therapeutic use , Adult , COVID-19/epidemiology , Female , France/epidemiology , Gestational Age , Humans , Male , Middle Aged , Nurse Midwives/statistics & numerical data , Pandemics , Physicians/statistics & numerical data , Pregnancy , Retrospective Studies , Surveys and Questionnaires , Telemedicine/statistics & numerical data
9.
Perspect Sex Reprod Health ; 52(4): 217-225, 2020 12.
Article in English | MEDLINE | ID: covidwho-963789

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.


Subject(s)
Abortion, Induced/statistics & numerical data , Ambulatory Care Facilities/statistics & numerical data , COVID-19 , Practice Patterns, Physicians'/statistics & numerical data , Female , Health Care Surveys , Humans , Pregnancy , SARS-CoV-2 , United States
12.
J Med Internet Res ; 22(8): e20961, 2020 08 06.
Article in English | MEDLINE | ID: covidwho-680328

ABSTRACT

BACKGROUND: In the past few months, the coronavirus disease (COVID-19) pandemic has caused extensive economic and social damage. OBJECTIVE: The purpose of this study was to assess the impact of COVID-19-related measures on partner relationships and sexual and reproductive health in China. METHODS: From May 1 to 5, 2020, 3500 young Chinese individuals were recruited through WeChat or Weibo to participate in a survey to obtain information on sexual and reproductive health (eg, sexual desire, frequency of sexual intercourse, sexual satisfaction, etc). The questionnaire also collected demographic data (eg, age, race, education, current financial status, sexual orientation, relationship status, etc). RESULTS: In total, 967 participants were included in the sexual health analysis. Due to the COVID-19 pandemic and related containment measures, 22% of participants (n=212) reported a decrease in sexual desire; 41% (n=396) experienced a decrease in the sexual intercourse frequency; 30% (n=291) reported an increase in the frequency of masturbation; 20% (n=192) reported a decrease in alcohol consumption before or during sexual activities, and 31% (n=298) reported a deterioration in partner relationships during the pandemic. The logistic regression analysis indicated that the following influenced partner relationships: accommodations during the pandemic (P=.046; odds ratio [OR] 0.59; 95% CI 0.30-0.86); exclusive relationship status (yes or no) (P<.001; OR 0.44; 95 % CI 0.27-0.73); sexual desire (P=.02; OR 2.01; 95% CI 1.38-2.97); and sexual satisfaction (P<.001; OR 1.92; 95% CI 1.54-2.50). COVID-19 also caused disruptions in reproductive health services such as prenatal and postnatal care, childbirth and abortion services, contraception availability, and the management of sexually transmitted infections. CONCLUSIONS: Our results show that many young people have wide-ranging issues affecting their sexual and reproductive health due to the COVID-19 pandemic and related containment measures. Strategies and guidelines are needed to safeguard the sexual and reproductive health of young people during this pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Health Surveys , Pandemics , Pneumonia, Viral/epidemiology , Reproductive Health/statistics & numerical data , Sexual Behavior/statistics & numerical data , Sexual Health/statistics & numerical data , Abortion, Induced/statistics & numerical data , Adolescent , Adult , COVID-19 , China/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Odds Ratio , Perinatal Care/statistics & numerical data , Pregnancy , Sexual Partners/psychology , Sexually Transmitted Diseases/therapy , Social Isolation , Young Adult
14.
J Perinat Med ; 48(9): 943-949, 2020 Nov 26.
Article in English | MEDLINE | ID: covidwho-634514

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was first identified in December 2019 in Wuhan, China and spread rapidly, affecting many other countries. The disease is now referred to as coronavirus disease 2019 (COVID-19).The Italian government declared a state of emergency on 31st January 2020 and on 11th March World Health Organization (WHO) officially declared the COVID-19 outbreak a global pandemic. Although the COVID-19 incidence remained considerably lower in Sardinia than in the North Italy regions, which were the most affected, the field of prenatal screening and diagnosis was modified because of the emerging pandemic. Data on COVID-19 during pregnancy are so far limited. Since the beginning of the emergency, our Ob/Gyn Department at Microcitemico Hospital, Cagliari offered to pregnant patients all procedures considered essential by the Italian Ministry of Health. To evaluate the influence of the COVID-19 pandemic on the activities of our center, we compared the number of procedures performed from 10th March to 18th May 2020 with those of 2019. Despite the continuous local birth rate decline, during the 10-week pandemic period, we registered a 20% increment of 1st trimester combined screening and a slight rise of the number of invasive prenatal procedures with a further increase in chorionic villi sampling compared to amniocentesis. Noninvasive prenatal testing remained unvariated. The request for multifetal pregnancy reduction as a part of the growing tendency of voluntary termination of pregnancy in Sardinia increased. The COVID-19 pandemic provides many scientific opportunities for clinical research and study of psychological and ethical issues in pregnant women.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pandemics/statistics & numerical data , Pneumonia, Viral/diagnosis , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/virology , Prenatal Diagnosis/statistics & numerical data , Abortion, Induced/statistics & numerical data , Amniocentesis/statistics & numerical data , COVID-19 , Chorionic Villi Sampling , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Female , Humans , Italy/epidemiology , Male , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pregnancy , Pregnancy Complications, Infectious/prevention & control , Pregnancy Reduction, Multifetal/statistics & numerical data , Pregnancy Trimester, First , Prenatal Diagnosis/methods , SARS-CoV-2 , Ultrasonography, Prenatal/statistics & numerical data
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