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The coronavirus pandemic has widened existing gaps in access to abortion services across Europe and found a review of nationwide policy changes in response to COVID-19 published in BMJ Sexual & Reproductive Health magazine.
However, forced innovations introduced in some countries, such as telemedicine and the provision of home abortions, could reverse this trend and create a permanent change in this essential health service, the researchers suggest.
Abortion is one of the most common procedures for women of childbearing age in Europe and ranges from 6.4 / 1000 women aged 15 to 44 in Switzerland to 19.2 / 1000 in Sweden. The need for it is likely to have increased in the wake of COVID-19 due to economic uncertainties, increased exposure to sexual violence, and limited access to contraception, the researchers say.
Given the massive public health measures restricting free movement at the height of the pandemic, they wanted to see what impact this could have on access to abortion services across Europe.
They have therefore compiled information on practice in 46 countries / regions. Survey information completed by national experts was collected for 31, while desk research was conducted for the remaining 15.
The data showed that European countries have taken different approaches in response to the pandemic, ranging from imposing restrictions to easing certain requirements.
New restrictions included delaying or denying abortion care to women with COVID-19 symptoms or living with women who have had them, as well as decreased availability of surgical abortions. Some countries have expanded the availability of medical abortions via telemedicine and relaxed regulations on the use of drugs to induce medical abortions.
In detail, abortions were banned in six countries (Andorra, Liechtenstein, Malta, Monaco, San Marino and Poland) and suspended in one (Hungary).
Access to surgical abortions was restricted in 12 countries / regions, and services for women with COVID-19 symptoms were unavailable or delayed in 11 countries: Netherlands, Belgium, Germany, Iceland, Latvia, Luxembourg, Montenegro, Slovenia, England, Wales and Scotland. No country has increased its pregnancy limit for abortion.
Changes have been made in 13 countries / regions (Belgium, Estonia, Ireland, Finland, France, Germany, Norway, Portugal, Switzerland, England, Wales, Scotland and Northern Ireland) to reduce the number of face-to-face consultations.
But only seven countries / regions offered abortion through telemedicine. In two cases this was foreseen before the pandemic (Denmark and the Swedish Stockholm region) and in five other countries (England, Wales, Scotland, France and Ireland).
Eight countries / regions supplied mifepristone and misoprostol after 9 weeks (up to 11 weeks + 6 days) with mifepristone and misoprostol at home, while 13 countries / regions did so for up to 9 weeks.
Pharmacy access to prescribed mifepristone was allowed in two countries / regions: Denmark, where it was allowed before COVID-19, and France, where it was not allowed before. And these drugs could be mailed in England, Wales, Scotland and Georgia or home in England, Wales, Scotland and Ireland.
“Abortion is an integral part of sexual and reproductive care for women. While extremely safe following recommended practices, it is responsible for significant maternal morbidity and mortality if women do not have access to safe abortion care,” the researchers point out .
Abortion services are particularly vulnerable to measures to restrict care because “policy often trumps evidence,” they point out. “With every week of political inactivity, thousands of women are being denied treatment that cannot be postponed and facing the prospect of terminating unwanted pregnancies or undergoing unsafe procedures,” they add.
“Overall, the diversity of pre-COVID-19 rules regulating abortion, coupled with inconsistent responses to the COVID-19 crisis, has exacerbated a heterogeneous landscape of abortion care in Europe,” the researchers write.
“The lack of political will to lift unnecessary regulations is disheartening, but we recognize the concerted efforts of some governments and providers who have acted swiftly in COVID-19 disruptions to maintain abortion services,” they note.
And they conclude: “The lack of a unified policy response to COVID-19 restrictions has widened inequalities in access to abortion in Europe, but some innovations, including the telemedicine used during the outbreak, could act as a catalyst for ensuring that Serving continuity and equity in abortion care.
“We believe that these advances, mostly intended as a temporary response to a health crisis, could serve as a catalyst for ‘liberalizing’ abortion care and that it should become the standard of care.”
Dr. Edward Morris, President of the Royal College of Obstetricians and Gynecologists (RCOG) who owns the magazine, commented, “This review has highlighted some of the shocking inequalities in access to abortion care across Europe during the COVID-19 pandemic.”
He continues: “Telemedicine for abortion, introduced in England, Scotland and Wales, has given thousands of women access to safe abortion care during the COVID-19 pandemic. This is a time of access to other vital health services was disabled for women.
“We have seen that this simple but effective innovation has tremendous benefits for women. Waiting times for women who have requested an abortion have been reduced, visits to clinics have been reduced, which has limited the transmission of COVID The virus in women and employees and the complications associated with abortion have decreased. “
He added: “We applaud the moves by governments to ensure that abortion care continues to be safe, timely and compassionate, and particularly welcome the new innovative ways in abortion care, including the introduction of telemedicine in some countries, including the UK We urge governments to ensure that these positive changes continue after the pandemic. ”
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Abortion Regulation in Europe in the Age of COVID-19: A Spectrum of Policy Responses, DOI: 10.1136 // bmjsrh-2020-200724 Provided by the British Medical Journal
Quote: The pandemic has widened the existing gaps in access to abortion services across Europe (2020, October 8), which will be published on October 9, 2020 at https://medicalxpress.com/news/2020-10-pandemic-widened-gaps- access-abortion.html
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