Abortion services during the COVID-19 pandemic: a systematic review

Selection and characteristics of included studies

The study selection process is shown in Fig. 1. One hundred fifty-one records were identified through the database and reference lists of articles. After removing duplicated records, 112 records remained; finally, 25 full-text articles were assessed for eligibility and seventeen articles have been included: Cross-sectional [17,18,19, 32, 33], prospective [20, 23, 34], retrospective [23, 24] cohort, qualitative [20, 25], mixed-method [21, 22], descriptive [26,27,28,29,30] studies and a newspaper [29]. Included studies have been conducted in USA, France, Belgium, UK, Scotland, Mexico, Columbia, Nepal, and eight European countries, as showed in Table 1.

Table 1 Characteristics of included studies and their main findingCOVID-19 and abortion

The results showed that during the COVID -19 pandemic, requests for access to medication abortion by telemedicine and demand for self-managed medication abortion had been increased [20,21,22,23,24, 26, 28, 29, 34,35,36]. In contrast, the number of abortion requests and procedures in the abortion centers were generally dropped [31]. It was more significant in the most severe and longest-lasting lockdowns [28]. In another report, the number of visits to abortion clinics has been reduced by 32%, with an additional 23% reduction in areas where abortion is prohibited [18]. Travel restrictions [32], lockdowns [22, 27, 28], and fear of COVID-19 [17] were among reasons to choose telemedicine abortion. Request for telemedicine abortion was reported based on location and distance from the hospital [32].

Satisfaction in telemedicine service

Numerous studies described tele-abortion safe, effective [20, 29, 32], very acceptable [20, 32, 34], and satisfying for women [23, 26, 29]. More individuals preferred medical abortion to surgical abortion [17]. In one study, the most frequent reasons to choose telemedicine abortion were privacy (38.3%), secrecy (46.2%), and comfort (34.9%) [22].

According to the results of a qualitative research, the quality of abortion care was improved in telemedicine services due to access, comfort, flexibility, and ongoing telephone support [20, 32]. It also reported that self-sourced medication abortion was safe, effective, and empowering for women [32, 33]. Another report showed no significant difference in satisfaction of services during and after lockdown (p = 0.690) [17].

Complications and challenges of tele-abortion

The most reported complications of mothers were bleeding [24, 34], pain [24, 34], and need to blood transfusions (0.4%) [26]. The COVID-19 pandemic had created many challenges in abortion clinics, including changes in the work style of healthcare providers, increased costs, and reduced revenue, but care activities continued [37, 38]. Using medication abortion and present telemedicine services without ultrasound has also been reported [20, 23, 33].

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