Changes of trends in contraception in pandemic - a hospital-based study

Background: With the onset of COVID-19 pandemic, the life of humankind had changed a lot. With a change in health-care approach, contraception became a non-essential service and faced a downfall. Aims and Objective: This study objective is to find out the changes in contraceptive usage in a tertiary care center. Materials and Methods: The study is a retrospective observational study, in which contraceptive usage was compared between 2019 and 2020. Data obtained from record section of the institute were used as source. Attendance in Gynecological Outpatient Department, admission in maternity ward, and delivery rates were also compared between 2 years. Results: Total contraceptive usage was decreased by 11.1% in 2020. Long-acting reversible contraceptives or short-acting both types were decreased in 2020, but maximum decrease was barrier method condom by 25.1% and oral contraceptive pills by 24.9%. Hospital maternity ward admission was less by 7% and delivery rates by 2.4%. Only medical termination of pregnancy showed an increased trend in 2020. Conclusion: Pandemic also had caused a toll in family planning, and thus, overall decrease in usage was seen which can be detrimental to population control.

Women's decision-making related to induced abortion - a cross sectional study during a period of Covid-19 pandemic, in Sweden.

OBJECTIVES: To investigate women's decision-making on induced abortion. MATERIALS AND METHODS: A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion was measured using a 7-point Likert scale, and analysed with univariate and multivariate analysis (odds ratios [OR], 95% confidence intervals [CI]). RESULTS: About half (n = 322;52%) scored 1-4, suggesting the decision was perceived as easier compared to those (n = 292;48%) who scored 5-7. Reasons for the abortion were: poor economy (n = 166;27%), too early in the relationship (n = 154;25.1%), want to work first (n = 147;23.9%), want to study first (n = 132;21.5%), uncertain about the relationship (104;16.9%), and too young (n = 104;16.9%). Predictors for perceiving the decision as difficult: partner's hesitance (OR = 3.18, CI:1.76-5.73), being born outside the Nordic countries (OR = 2.23, CI:1.28-3.87), having discussed the decision with someone (OR = 2.42, CI:1.67-3.50), age ≥30 (OR = 2.22, CI:1.03-4.76), the Covid-19 pandemic (OR = 2.08, CI:1.20-3.59), and the desire to have children in the future (OR = 1.96, CI:1.18-3.28). After confirmed pregnancy, poor mental well-being was more common among those who scored 5-7 (n = 140;47.9%) compared to those who scored 1-4 (n = 122;37.9), p = .029. CONCLUSION: Women's decision-making on abortion is complex; in times of crises, the decision procedure may be even more difficult. This valuable knowledge could be used to improve and promote satisfactory counselling beyond medical routines.

Barriers to Telemedicine for First-Trimester Medical Abortion Provision in Canada in 2019

Objectives: In 2017, mifepristone became available for first trimester medical abortion (FTMA) in Canada. Shortly after, regulations permitted pharmacies to dispense mifepristone to patients, facilitating telemedicine provision. Our objective was to explore the barriers to providing FTMA using telemedicine in Canada in 2019. Methods: We conducted a cross-sectional, national, self-administered, anonymized survey of physicians and nurse practitioners who provided abortion care in Canada in 2019. Online invitations were sent through professional health organizations using a modified Dillman technique to optimize recruitment. Questions elicited provider demographics and perceived barriers to offering telemedicine FTMA. We used R software for descriptive statistics. Results: Four hundred sixty-five clinicians were included for analyses, of which 388 reported providing FTMA. Among those, 44.0% reported using telemedicine (for consultations, while often obtaining testing) for FTMA. British Columbia respondents reported the highest proportion of telemedicine use at 63.8%;the lowest was in Québec (10.7%). The majority of FTMA respondents (77.7%) reported barriers to telemedicine. The most common barriers were inability to confirm gestational age with ultrasound (43.0%), and lack of provincial fee code to pay practitioners (30.2%), timely access to serum hCG testing (24.6%), and nearby emergency services (23.3%). Few reported facility regulations (8.9%) and provincial regulations (4.9%) as barriers to providing telemedicine-based care;provincial regulation barriers were most common in Québec (16.1%). Conclusions: Less than half of respondents reported providing some abortion care via telemedicine and the majority perceived barriers. Low-test medical abortion protocols developed during COVID-19 have the potential to overcome some barriers. Keywords: telemedicine;abortion, induced;surveys and questionnaires;Canada;delivery of health care;mifepristone

Evolution of Legislation and the Incidence of Elective Abortion in Spain: A Retrospective Observational Study (2011-2020).

BACKGROUND: According to the WHO, "unsafe abortion occurs when a pregnancy is terminated either by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both". AIM: To review the legislation that ensures access to elective abortion and the main indicators of elective abortion in Spain. METHODS: A retrospective observational study was conducted across all regions of Spain from 2011 to 2020. The regulations of each region on the creation of the clinical committee and the creation of the registry of conscientious objector professionals were identified. Data were collected on rates of elective abortions per 1000 women, type of health center where the intervention was performed, interval of weeks of gestation, and cause. RESULTS: After Law 2/2010 entered into force, the Spanish regions created a clinical committee; however, very few regions have a registry of conscientious objectors. During the study period, the average annual rate in Spain was 11.10 elective abortions per 1000 women between 15 and 44 years of age, showing a decreasing trend (annual percentage change of -1.92%). Only 10.67% of abortions were performed at public centers. In 90.18% of the cases, abortions were performed at the woman's request. CONCLUSION: Spain legislated late compared to most European Union countries. The current law is similar to that of other member states, allowing abortion at the woman's request in the first fourteen weeks and thereafter for medical reasons. Most abortions are performed at private centers, although many territorial inequalities are observed.

Tracing framing processes in the abortion debate: An ethnographic investigation of a pro-life lobbying organization

COVID, coupled with a flurry of black deaths at the hands of policemen, has spawned a new era of social movements. As online environments have multiplied, so have people's options for civic engagement. As a result, the field of writing studies and rhetoric is full of new research that questions what a social movement is and what it can do. However, it has yielded little empirical data that details the behind-the-scenes activity of a social movement organization. How can we understand what constitutes a social movement today if we rely only on what we see happening in the streets or on the internet? Such a front stage view only allows us access to the final product of activism, and thus, obscures the complex circumstances that catalyze and shape civic engagement. This research is an attempt to understand such circumstances, especially those related to writing as a tool to gain a more powerful position within a social movement network.In addition to there being little empirical research on social movements within writing studies and social movement rhetoric, there is a scarce body of literature that addresses how conservative social movements work. For many, the election of Donald Trump on the heels of our first black president has revealed surprising facts about our culture as fears about immigration, gun control, and abortion have been inflamed. Political debates about race, climate change, voter suppression, and reproductive rights restrictions make the study of conservative rhetorical tools even more critical. Using one prominent pro-life lobbying and social movement organization as my specifying site, this dissertation study aims to understand what motivates, influences, and facilitates a social movement. What entanglement of ideology, circumstances, and personal attachments exist within an activist organization, and how do these factors influence the language and delivery methods of such defining documents as mission statements, donor letters, legislation, and recruitment materials? Inspired by sociohistoric scholars like Clay Spinuzzi, Stephen Witte, and Bruno Latour, this dissertation project answers writing and rhetoric scholars' call for more interdisciplinarity to reinvigorate the study of social movement within the field. By tracing the actors in a prominent pro-life organization, I was compelled to reckon with activity outside the bounds of writing and rhetoric to gain a fuller picture of how this organization garners support and achieves organizational goals. In addition, relying on Iddo Tavory and Stefan Timmermans' (2014) methodological theory, Abductive Analysis, I consulted numerous disciplines outside my own to better understand this lobbying and social movement organization;thus, this project serves as an example to other scholars who wish to more closely investigate the complexities of both the front and backstage literate activity that has contributed to an organization's rise to power. . (PsycInfo Database Record (c) 2021 APA, all rights reserved)

The perspective of Canadian health care professionals on abortion service during the COVID-19 pandemic.

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.

Induced abortion and COVID-19 as contributing factors to declining fertility in Sardinia.

OBJECTIVES: Decreasing fertility implies considerable public health, societal, political, and international consequences. Induced abortion (IA) and the recent COVID-19 pandemic can be contributing factors to it but these have not been adequately studied so far. The purpose of this paper is to explore the relation of IA incidence and the COVID-19 pandemic to declining rates of delivery, as per our Sardinian experience. METHODS: We analyzed the registered data from the official Italian statistics surveys of deliveries and IA in the last 10 years from 2011 to 2020 in Sardinia. RESULTS: A total of 106,557 deliveries occurred and a progressive decrease in the birth rate has been observed. A total of 18,250 IA occurred and a progressive decline has been observed here as well. The ratio between IA and deliveries remained constant over the decade. Between 2011 and 2019 a variation of -4.32% was observed for IA while in the last year, during the COVID-19 pandemic the decrease of the procedures was equal to -12.30%. For the deliveries, a mean variation of the -4.8% was observed between the 2011 and the 2019 while in the last year, during the COVID-19 pandemic the decrease was about -9%. Considering the about 30% reduction of live births between 2011 and 2020, there is an almost proportional reduction in IA. CONCLUSIONS: Public policy responses to decreasing fertility, especially pronatalist ones, would be provided with evidence base about trends in delivery and IA and women's decision making.

Greasing the wheels: The impact of COVID-19 on US physician attitudes and practices regarding medication abortion.

OBJECTIVE: To explore US provider perspectives about self-sourced medication abortion and how their attitudes and clinic practices changed in the context of the COVID-19 pandemic. STUDY DESIGN: We conducted a multi-method study of survey and interview data. We performed 40 baseline interviews and surveys in spring 2019 and 36 follow-up surveys and ten interviews one year later. We compared pre- and post-Likert scale responses of provider views on the importance of different aspects of standard medication abortion assessment and evaluation (e.g., related to ultrasounds and blood-typing). We performed content analysis of the follow-up interviews using deductive-inductive analysis. RESULTS: Survey results revealed that clinics substantially changed their medication abortion protocols in response to COVID-19, with more than half increasing their gestational age limits and introducing telemedicine for follow-up of a medication abortion. Interview analysis suggested that physicians were more supportive of self-sourced medication abortion in response to changing clinic protocols that decreased in-clinic assessment and evaluation for medication abortion, and as a result of physicians' altered assessments of risk in the context of COVID-19. Having evidence already in place that supported these practice changes made the implementation of new protocols more efficient, while working in a state with restrictive abortion policies thwarted the flexibility of clinics to adapt to changes in standards of care. CONCLUSION: This exploratory study reveals that the COVID-19 pandemic has altered clinical assessment of risk and has shifted practice towards a less medicalized model. Further work to facilitate person-centered abortion information and care can build on initial modifications in response to the pandemic. IMPLICATIONS: COVID-19 has shifted clinician perception of risk and has catalyzed a change in clinical protocols for medication abortion. However, state laws and policies that regulate medication abortion limit physician ability to respond to changes in risk assessment.

Family Physicians' Role in Simplifying Medication Abortion During the COVID-19 Pandemic.

Despite first trimester abortion being common and safe, there are numerousrestrictions that lead to barriers to seeking abortion care. The COVID-19 pandemic hasonly exacerbated these barriers, as many state legislators push to limit abortion accesseven further. During this pandemic, family physicians across the country haveincorporated telemedicine into their practices to continue to meet patient needs.Medication abortion can be offered to patients by telemedicine in most states, andmultiple studies have shown that labs, imaging, and physical exam may not beessential in all cases. Family physicians are well-poised to incorporate medicationabortion into their practices using approaches that limit the spread of the coronavirus,ultimately increasing access to abortion in these unprecedented times.

Post Abortion Care and Management After Induced Abortion During the COVID-19 Pandemic: A Chinese Expert Consensus.

The rapid spread of novel coronavirus (COVID-19) has posed complex challenges to global public health. During this pandemic period, access to essential services including post-abortion care (PAC) has been disrupted. Along with the clinical management of the disease in women, protection of the healthcare workers and medical staff from nosocomial infection is important to ensure infection control. Thus, in order to implement the proper contraceptive measures and to reduce the rate of repeated abortion, the family planning group of minimally invasive gynecological branch of the Liaoning Medical Association organized a committee of experts to formulate guidance and suggestions to ensure the timely treatment and surgery of women opting for abortion, the implementation of PAC, implementation of safe contraceptive measures after surgery, and the protection of healthcare professionals and medical staff from infection. We believe these guidelines might be helpful for obstetrics and gynecology departments in China and globally, as well for women who wish to undergo abortion during these unprecedented times.

Options for Teens with No Options: A Self-Managed Second Trimester Abortion.

BACKGROUND: Several states have deemed abortions as nonessential services, effectively calling for a halt to abortion care during the COVID-19 pandemic. In response, women might elect for self-managed abortions by obtaining abortion medications online. CASE: A 15-year-old girl presented with abdominal cramping and vaginal discharge after taking misoprostol obtained from an online retailer for a self-managed abortion in her second trimester during the COVID-19 pandemic. Her exam showed products of conception protruding from the vagina. The patient was emergently evaluated for an incomplete and possible septic abortion and underwent a dilation and evacuation procedure.