Abstract
Background: Abortion is an essential service, the need for which has increased during the coronavirus disease 2019 (COVID-19) pandemic. Because of the lockdowns at several periods, these services were hampered. This study analyzed the pattern of Safe Abortion Services (SAS) at a tertiary healthcare center during the first six months of the COVID-19 pandemic in Nepal. Methods: This is a cross-sectional analytical study. We compared the pattern of safe abortion services between the first three months of the pandemic when a lockdown was implemented and the second three months when the lockdown was eased. Demographic and obstetric profile of women, their abortion choices, method of termination, difficulty in accessibility, and level of psychological distress were studied. Results: A total of 52 women were provided SAS during the study period. The number of women coming for SAS during lockdown was 47.1% less than that after easing of the lockdown. During the lockdown, women came at a later period of gestation with a mean of 9.5 weeks compared to 7.5 weeks in the later three months. Because of fear of COVID-19, 19.2% (n=10) women opted for termination of pregnancy. Increased need of contraception was felt but 40% (n=12) had problems of accessibility. More women had probable serious mental illness during the lockdown period (p=0.008). Conclusion:Lockdown during the pandemic decreased the number of women coming for SAS due to barriers in accessibility. Contraceptive needs are also increased but access is difficult. The need for safe abortion services and contraception has increased during the pandemic but the lockdown caused inaccessibility. Psychological distress is prevalent, and fear of COVID-19 has become a common reason for termination of pregnancy. This pandemic can be taken as an opportunity to provide and improve contraception and abortion accessibility, and quality with integration of mental health support.
Highlights
Safe Abortion Services (SAS) in Nepal include pre and post counseling on abortion and contraception methods, termination of pregnancy, diagnosis, and treatment of existing reproductive tract infection, providing contraceptive methods as per informed choice, and follow up for post abortion complication management (National Safe Abortion Policy, 2003)
Three months prior to the lockdown (January–March 2020), 69 women were provided with SAS
The COVID-19 pandemic has had a profound effect on sexual and reproductive health (SRH), and the findings of this study suggest that abortion and contraceptive services, which form a major component of SRH, have been affected to a great extent
Summary
Safe Abortion Services (SAS) in Nepal include pre and post counseling on abortion and contraception methods, termination of pregnancy, diagnosis, and treatment of existing reproductive tract infection, providing contraceptive methods as per informed choice, and follow up for post abortion complication management (National Safe Abortion Policy, 2003). 3b) Duration – it would be better if we remove unnecessary paragraphs and better to focus on study duration only (no need to mention-the demographic and obstetric profile of these women about their abortion choices included the reason for termination of pregnancy and method of termination, the difficulty they are facing relating to access to these services, and their level of psychological distress were studied.). This study analyzed the pattern of Safe Abortion Services (SAS) at a tertiary healthcare center during the first six months of the COVID-19 pandemic in Nepal. The need for safe abortion services and contraception has increased during the pandemic but the lockdown caused inaccessibility. Psychological distress is prevalent, and fear of COVID-19 has become a common reason for termination of pregnancy This pandemic can be taken as an opportunity to provide and improve contraception and abortion
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