Obstacles and opportunities: a qualitative study of the experiences of abortion centre staff with abortion care during the first COVID-19 lockdown in Flanders, Belgium

Abstract

The COVID-19 pandemic and corresponding measures impacted the organisation of services for abortion on request in Flanders, Belgium. This study describes abortion centre staff's perceptions of the influence of protective measures on abortion consultations and procedures, and aims to identify obstacles and opportunities that arose from this situation. Through the anonymised patient records of one Flemish abortion centre, we compared the number of requests and abortions during the first lockdown (16 March-14 June 2020) with the same period in the five preceding years. Using a phenomenological approach, we documented the procedures and conducted interviews (all inductively coded in Nvivo) with the centre's coordinator, seven psychosocial staff members and three doctors. Though fewer people requested and had an abortion, the pressure on the staff was high due to changed procedures. A substantial change was the substitution of telephone for in-person consultations, which the staff perceived as less suited for discussing worries, contraception counselling, and building trust. The centre remained accessible, but the staff perceived an influence on the emotional reactions of clients. Staff agreed that the lockdown did not negatively influence the abortion procedure itself. However, they felt a negative influence on the level of psychological support they could offer, especially in interactions with clients who were less certain of their choice and clients with whom there was no common language. When the lockdown was relaxed, a triage system was set up to ensure emotionally safe abortion careas perceived by stafffor all clients.

A qualitative study of abortion care providers’ perspectives on telemedicine medical abortion provision in the context of COVID-19

“…Similarly, as participants gained experience, they became more confident in their ability to safeguard patients by identifying those who were experiencing coercive control or domestic violence. The importance of experience in mitigating concerns among ACPs was a finding of the Belgian study 27 ; participants initially expressed concern that a reduction in in-person contact would be emotionally detrimental for patients; however, they reported that their ability to conduct telephone consultations improved as they gained experience. The NHS Lothian clinic leadership structures, including clear routes to accessing senior nursing and medical advice to support these decisions, were also identified as facilitators of safe telemedicine abortion care.…”

“…To our knowledge this is the first study to explore ACP perspectives of abortion care provision via telemedicine in the UK medicolegal context during COVID-19. There have been few other studies23 24 27 exploring ACP perspectives on the provision of telemedicine abortion care – two in the USA, both of which were prior to COVID-19, and one in Belgium during the COVID-19 pandemic. The telemedicine models and medicolegal contexts in these studies are different from the current UK setting.…”

“…There was unanimity among ACPs that telemedicine abortion care provision should continue beyond the pandemic, reflecting the sentiments of patients interviewed at a similar time in this clinic15 and providers in other settings 23 24 27…”

Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review

“…33 34 87 Access to postabortion care was negatively impacted as reported in China, 93 Ethiopia, 52 Uganda 53 and Belgium. 89 Two studies described an increase in abortion service utilisation at tertiary care facilities in the US 49 and among teenagers in Ethiopia. 68 Decreases in access or utilisation of remote or partially remote abortion services were described by three studies.…”

“…68 Decreases in access or utilisation of remote or partially remote abortion services were described by three studies. 88 89 108 Endler et al and DeKort et al observed declines in at-home medical abortion utilisation, and Aiken et al 90 found that telemedicine abortion requests through Women on Web, an online telemedicine abortion service, increased significantly in Portugal, Italy, Hungary, Malta and Northern Ireland, while they decreased significantly in the UK. This decrease is speculated to be caused by a change in abortion legislation in the UK, whereby access to no-test abortions through the formal health sector significantly increased.…”