Impact of the COVID-19 pandemic on induced abortions in France in 2020

Abstract

A major concern during the COVID-19 lockdowns was reduced access to time-sensitive reproductive healthcare, in particular, healthcare related to abortions.1Robinson E.F. Moulder J.K. Zerden M.L. Miller A.M. Zite N.B. Preserving and advocating for essential care for women during the coronavirus disease 2019 pandemic.Am J Obstet Gynecol. 2020; 223: 219-220.e1Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar France’s first lockdown from March 17 to May 10, 2020, consisted of strict stay-at-home orders that dramatically limited population movement.2Pullano G. Valdano E. Scarpa N. Rubrichi S. Colizza V. Evaluating the effect of demographic factors, socioeconomic factors, and risk aversion on mobility during the COVID-19 epidemic in France under lockdown: a population-based study.Lancet Digit Health. 2020; 2: e638-e649Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar Medical care was exempted from these restrictions, but pandemic-related health service reorganization and fears of infection created potential obstacles to abortion services. In France, abortions are permitted without restriction until 14 weeks of gestation (until 7 weeks’ gestation in an ambulatory setting). After 14 weeks of gestation, only abortions for severe anomalies or maternal health risks can be performed after authorization by a medical committee. To maintain access to abortion services, the government modified management of medical abortions by extending the gestational limit to 9 weeks in an ambulatory setting, authorizing telemedicine visits, and allowing direct pickup from pharmacies of call-in orders for mifepristone and misoprostol.3Moreau C. Shankar M. Glasier A. Cameron S. Gemzell-Danielsson K. Abortion regulation in Europe in the era of COVID-19: a spectrum of policy responses.BMJ Sex Reprod Health. 2021; 47: e14Crossref PubMed Scopus (29) Google Scholar,4Bojovic N. Stanisljevic J. Giunti G. The impact of COVID-19 on abortion access: insights from the European Union and the United Kingdom.Health Policy. 2021; 125: 841-858Crossref PubMed Scopus (2) Google Scholar This study aimed to investigate changes in the use of abortion services during and after this first very restrictive COVID-19 lockdown in France. We used data on the number of monthly abortions from 2016 to 2020 in France (N=1,104,408). Data on all procedural and medical abortions in hospitals and clinics are recorded in hospital discharge data, whereas medical abortions prescribed in doctors’ or midwives’ offices can be obtained from insurance claims data. We modeled the time series from 2016 to February 2020 to forecast the expected monthly values with their confidence intervals for March 2020 onward using an autoregressive integrated moving average model. Potential increases in delayed care were assessed by the percentage of abortions within 2 weeks of the legal limit. Live birth conceptions were estimated from birth registration data by subtracting 9 months from the date of birth, and monthly conceptions in 2020 were compared with those in 2018 and 2019. In 2020, the number of monthly abortions deviated from the predicted data in May and June, but the first 2 months of the lockdown in March and April were in line with expectations (Figure; full time series results in Supplemental Figure). Decreases in the number of abortions occurred in hospitals and clinics. The proportion of abortions at 13 to 14 weeks were similar in 2020 (2.3%) and 2019 (2.7%). In 2020, the estimated number of conceptions ending in a live birth was 123,271 in January and February, 112,335 in March and April, 113,521 in May and June, and 379,006 from July to December or −3.5%, −10.3%, −3.3%, and +1.4% respectively, of the conceptions that occurred during the same periods in 2019 and −5.1%, −11.1%, −1.2%, and −1.5% of those in 2018. We observed a reduction in the abortions during France’s strict COVID-19 lockdown, but the delayed time pattern, the stability of late abortions, and concurrent changes in live birth conceptions suggest that it was caused principally by declines in conceptions. This reduction occurred primarily among induced abortions in hospitals and clinics, and the number of these abortions continued to be lower than expected throughout 2020. However, the total number of abortions was in line with the expectations from July through December 2020 despite the second pandemic wave in September and October and a less restrictive lockdown in November.