The impact of COVID-19 lockdown on abortion care: a time series analysis of data from Marie Stopes Nepal

Abstract

The COVID-19 pandemic significantly impacted sexual and reproductive health and rights. Nepal implemented a nationwide lockdown in March 2020, limiting population movement and service access. The 36 clinics run by Marie Stopes Nepal (MSN) closed for varying periods at the beginning of lockdown. This study assesses the impact of lockdown and associated clinic closures on abortion services within MSN’s network. An interrupted time-series analysis of clinic-level MSN data compared abortion service use in the pre-closure and post-reopening periods, focusing on the following outcomes: number of abortion care visits, proportion of abortion-related visits, gestational age at time of abortion care and demographics of patients accessing abortion care. Subsequent meta-analyses combined clinic-level results to generate outcome-specific pooled effect estimates. As MSN clinics reopened, during ongoing wider lockdown, weekly visits for abortion care decreased by 37% on average, but abortion increased as a proportion of services post-reopening (OR: 1.53) compared with pre-closure, with no evidence of a change in the proportion of higher gestation abortions. The demographic profile of abortion care clients was altered, with post-reopening clients more likely to have completed primary education (OR: 1.54) and be aged 25 years or older (OR: 1.31) compared with pre-closure clients. COVID-19 lockdown and associated clinic closures reduced the absolute number of abortion services provided within MSN’s network, impacting the composition of service provision. Reductions in safe abortion and wider SRH access will have wide-ranging consequences, curtailing crucial reproductive rights. Policy-makers must ensure ongoing abortion access to protect rights and ensure access.

Increased demand for abortion information and advice during the COVID‐19 pandemic

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Access to sexual and reproductive health (SRH) care, including abortion information and services, has become even more challenging and inequitable during the COVID-19 pandemic and associated lockdowns (quarantines) globally and in Australia. [1][2][3] We undertook an audit of routinely collected Talkline data (Talkline is run by Family Planning NSW and provides free and confidential SRH information and advice for community members and health professionals in New South Wales (NSW), Australia) to compare enquiries regarding abortion care before and during the pandemic to better understand the changes in the nature of the calls and demographics of callers.Call enquiries and self-reported demographics of callers were extracted from the Talkline database between January 2019 and December 2021. No identifiable information is recorded in this database.

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Impact of policy changes of Medicare-rebated telehealth services on medical abortions provided at a family planning service during the coronavirus (COVID-19) pandemic

“…The coronavirus disease 2019 (COVID-19) pandemic has highlighted disparities in access to sexual and reproductive health (SRH) care, including access to abortion care globally and in Australia. [1][2][3] In response to the pandemic, Medicare, Australia's universal healthcare insurance scheme funded by Australian tax-payers, introduced nationwide rebates for telehealth in March 2020. 4 This created new opportunities to provide abortion services via telehealth to complement existing face-to-face (F2F) services in Australia.…”