The COVID-19 pandemic has widened the gaps that exist in accessing abortion services across Europe, according to a review published today.
However, researchers writing in BMJ Sexual & Reproductive Health say that telemedicine and the provision of abortion at home, could prompt long lasting change for this essential health service.
The team, from Johns Hopkins University Bloomberg School of Public Health, USA, Centre for Research in Epidemiology and Population Health (CESP) in France, the University of Edinburgh, UK, NHS Lothian, Scotland, and the Karolinska Institute in Sweden, compiled information on practice in 46 countries and regions in Europe.
Survey information, filled in by national experts, was collected for 31 of those, while desk research was carried out for the remaining 15.
The researchers found that European countries adopted different approaches when the pandemic first occurred, with some imposing restrictions, including delay or denial of abortion care to women with COVID-19 symptoms, or living with those who had them, and decreased availability of surgical abortion.
However, some countries expanded medical abortion availability via telemedicine, and relaxed regulations around the use of drugs to induce medical abortion.
The researchers found that abortions were banned in Andorra, Liechtenstein, Malta, Monaco, San Marino and Poland, and suspended Hungary, while access to surgical abortion was restricted in 12 countries/regions.
Services were unavailable or delayed for women with COVID-19 symptoms in The Netherlands, Belgium, Germany, Iceland, Latvia, Luxembourg, Montenegro, Slovenia, England, Wales and Scotland. No country expanded its gestational limit for abortion.
Reduced face-to-face consultations were made in Belgium, Estonia, Ireland, Finland, France, Germany, Norway, Portugal, Switzerland, England, Wales, Scotland and Northern Ireland, and seven countries/regions offered abortion by telemedicine. Of the seven, Denmark and the Stockholm region of Sweden provided this pre-pandemic, while England, Wales, Scotland, France and Ireland adopted it.
Eight countries/regions provided home medical abortion with mifepristone and misoprostol up to 11 weeks +6 days, while 13 countries/regions did so up to 9 weeks.
Pharmacy access to prescribed mifepristone was permitted in two countries/regions: Denmark, where it was permitted before COVID-19, and France, where it had not been permitted before. These drugs could be delivered by post in England, Wales, Scotland and Georgia or home delivered in England, Wales, Scotland and Ireland.
The researchers write that abortion services are particularly vulnerable to any move to restrict provision, because “politics often trumps evidence.”
“Altogether, the diversity of pre-COVID-19 rules regulating abortion coupled with inconsistent responses to the COVID-19 crisis has exacerbated a heterogeneous landscape of abortion provision in Europe,” they write.
Moreau C, Shankar M, Glasier A et al. Abortion regulation in Europe in the era of COVID-19: a spectrum of policy responses. BMJ Sexual & Reproductive Health 9 October 2020
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