Abstract
BackgroundThe COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic.ObjectiveWe sought to characterize the experiences of abortion health care professionals in Canada during the COVID-19 pandemic and the impact of the pandemic response on abortion services.MethodsWe conducted a sequential mixed methods study between July 2020 and January 2021. We invited physicians, nurse practitioners and administrators to participate in a cross-sectional survey containing an open-ended question about the impact of the pandemic response on abortion care. We employed an inductive codebook thematic analysis, which informed the development of a second, primarily quantitative survey.ResultsOur initial survey had 307 respondents and our second had 78. Fifty-three percent were family physicians. Our first survey found respondents considered abortion access essential. We identified three key topicss: access to abortion care was often maintained despite pandemic-related challenges (e.g. difficulty obtaining tests, additional costs); change of practice to low-touch medication abortion care and provider perceptions of patient experience, including shifting demand, telemedicine acceptability and increased rural access. The second survey indicated uptake of telemedicine medication abortion among 89% of participants except in Quebec, where regulations meant procedures were nearly exclusively surgical. Restrictions did not delay care according to 76% of participants.ConclusionsCanadian health care professionals report their facilities deemed abortion an essential service. Provinces and territories, except Quebec, described a robust pandemic transition to telemedicine to ensure access to services.PodcastAn accompanying podcast is available in the Supplementary Data, in which the authors Dr Madeleine Ennis and Kate Wahl discuss their research on how family planning care and access to abortion services have changed during the COVID-19 pandemic.
Highlights
The COVID-19 pandemic and pandemic response created novel challenges for abortion services
We identified three common topics related to the impact of the COVID-19 pandemic on abortion care in Canada: access to care, change in practice and perceptions of the patient experience
Access to abortion care Many abortion providers indicated that the pandemic did not affect their ability to provide access because they or their province considered abortion care essential
Summary
The COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic. Objective: We sought to characterize the experiences of abortion health care professionals in Canada during the COVID-19 pandemic and the impact of the pandemic response on abortion services. The second survey indicated uptake of telemedicine medication abortion among 89% of participants except in Quebec, where regulations meant procedures were nearly exclusively surgical. Progressive responses focussed on preserving access through telemedicine for early medical abortion (MA) care, since this minimized clinical points of contact and decreased the risk of COVID-19 exposure. An exception exists in the province of Quebec, which uniquely maintained restrictions that effectively limited MA care, and promoted surgical services [14,15]. Barriers to providing MA care in Quebec include restrictive provincial medical licensing body policies, restrictive facility approaches with perceived vested interests in preserving surgical provision, lack of inter-professional support and general professional uncertainty about the regulations [14]
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