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      Legal and policy responses to the delivery of abortion care during COVID‐19

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          Abstract

          Access to abortion care has long been a global challenge, even in jurisdictions where abortion is legal. The COVID‐19 pandemic has exacerbated barriers to access, thereby preventing many women from terminating unwanted pregnancies for an extended period. In this paper, we outline existing and COVID‐specific barriers to abortion care and consider potential solutions, including the use of telemedicine, to overcome barriers to access during the pandemic and beyond. We explore the responses of governments throughout the world to the challenge of abortion access during the pandemic, which are an eclectic mix of progressive, neutral, and regressive policies. Finally, we call on all governments to recognize abortion as essential healthcare and act to ensure that the law does not continue to interfere with providers’ ability to adapt to circumstances and to guarantee safe and appropriate care not only during the pandemic, but permanently.

          Abstract

          COVID‐19 has exacerbated pre‐existing barriers to abortion care globally. This paper highlights how legal and policy responses have protected or hindered equitable access to abortion.

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          Feminism and the Power of Law

          Carol Smart (2002)
          Book 0 comments Cited 105 times – based on 0 reviews
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            Is Open Access

            Telemedicine for medical abortion: a systematic review

            M Endler, A Lavelanet, A Cleeve … (2019)
            Background Telemedicine is increasingly being used to access abortion services. Objective To assess the success rate, safety, and acceptability for women and providers of medical abortion using telemedicine. Search strategy We searched PubMed, EMBASE, ClinicalTrials.gov, and Web of Science up until 10 November 2017. Study criteria We selected studies where telemedicine was used for comprehensive medical abortion services, i.e. assessment/counselling, treatment, and follow up, reporting on success rate (continuing pregnancy, complete abortion, and surgical evacuation), safety (rate of blood transfusion and hospitalisation) or acceptability (satisfaction, dissatisfaction, and recommendation of the service). Data collection and analysis Quantitative outcomes were summarised as a range of median rates. Qualitative data were summarised in a narrative synthesis. Main results Rates relevant to success rate, safety, and acceptability outcomes for women ≤10+0 weeks’ gestation (GW) ranged from 0 to 1.9% for continuing pregnancy, 93.8 to 96.4% for complete abortion, 0.9 to 19.3% for surgical evacuation, 0 to 0.7% for blood transfusion, 0.07 to 2.8% for hospitalisation, 64 to 100% for satisfaction, 0.2 to 2.3% for dissatisfaction, and 90 to 98% for recommendation of the service. Rates in studies also including women >10+0 GW ranged from 1.3 to 2.3% for continuing pregnancy, 8.5 to 20.9% for surgical evacuation, and 90 to 100% for satisfaction. Qualitative studies on acceptability showed no negative impacts for women or providers. Conclusion Based on a synthesis of mainly self‐reported data, medical abortion through telemedicine seems to be highly acceptable to women and providers, success rate and safety outcomes are similar to those reported in literature for in‐person abortion care, and surgical evacuation rates are higher. Tweetable abstract A systematic review of medical abortion through telemedicine shows outcome rates similar to in‐person care.
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              Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries

              S. Singh, I Maddow-Zimet (2015)
              With changing conditions affecting receipt of postabortion care, an updated estimate of the incidence of treatment for complications from unsafe pregnancy termination is needed to inform policies and programmes. National estimates of facility-based treatment for complications in 26 countries form the basis for estimating treatment rates in the developing world. An estimated seven million women were treated in the developing world for complications from unsafe pregnancy termination in 2012, a rate of 6.9 per 1000 women aged 15–44 years. Regionally, rates ranged from 5.3 in Latin America and the Caribbean to 8.2 in Asia. Results inform policies to improve women’s health.
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                Author and article information

                Contributors
                Elizabeth Chloe Romanis: elizabeth.c.romanis@durham.ac.uk
                Journal
                Journal ID (nlm-ta): Int J Gynaecol Obstet
                Journal ID (iso-abbrev): Int J Gynaecol Obstet
                Journal ID (doi): 10.1002/(ISSN)1879-3479
                Journal ID (publisher-id): IJGO
                Title: International Journal of Gynaecology and Obstetrics
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0020-7292
                ISSN (Electronic): 1879-3479
                Publication date (Electronic): 05 October 2020
                Publication date (Print): December 2020
                Publication date PMC-release: 05 October 2020
                Volume: 151
                Issue: 3 ( doiID: 10.1002/ijgo.v151.3 )
                Pages: 479-486
                Affiliations
                [ 1 ] Centre for Ethics and Law in the Life Sciences Durham Law School Durham University Durham UK
                [ 2 ] Centre for Ethics in Medicine Bristol Medical School University of Bristol Bristol UK
                Author notes
                [*] [* ] Correspondence

                Elizabeth Chloe Romanis, Durham Law School, Durham University, Durham, UK.

                Email: elizabeth.c.romanis@ 123456durham.ac.uk

                Article
                Publisher ID: IJGO13377
                DOI: 10.1002/ijgo.13377
                PMC ID: 9087790
                PubMed ID: 32931598
                SO-VID: f94fc0e7-7842-451b-b981-6ac266ef54ab
                Copyright © © 2020 International Federation of Gynecology and Obstetrics
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Page count
                Figures: 0, Tables: 0, Pages: 8, Words: 6680
                Categories
                Subject: Ethical and Legal Issues in Reproductive Health
                Subject: Ethical and Legal Issues in Reproductive Health
                Custom metadata
                source-schema-version-number 2.0
                cover-date December 2020
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.5 mode:remove_FC converted:10.05.2022

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: abortion,autonomy,covid‐19,reproductive health,reproductive rights,sexual health,telemedicine
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: abortion, autonomy, covid‐19, reproductive health, reproductive rights, sexual health, telemedicine

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