Abortion rates remain lower compared with pre-pandemic rates

Abortion rates remain lower compared with pre-pandemic rates

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1609

Editorial: https://www.acpjournals.org/doi/10.7326/M23-2582

URL goes live when the embargo lifts  An analysis of both medical and procedural abortions found that the overall incidence rate of abortions decreased by 14 percent during the early phase of the COVID-19 pandemic and did not return to pre-pandemic rates by June 2022. The analysis is published in Annals of Internal Medicine.

The in-person dispensing requirement that has been standard for mifepristone since the drug was approved was not enforced from July 2020 to January 2021 and after April 2021, creating an opportunity for increased patient access to medical abortions via telehealth. However, the extent to which these regulatory changes were communicated to abortion providers in the United States or resulted in changes in how abortion care was delivered is unknown.

Researchers from Brigham and Women’s Hospital and Harvard Medical School studied medical and procedural abortion rates among commercially-insured women, aged 15 to 44 years, from January 2018 to June 2022. The authors found that prior to the COVID-19 pandemic, the incidence rate of abortions was 151 per million women, with equal rates of medical and procedural abortions. After March 2020, there was an immediate 14 percent decrease in the monthly incidence rate of abortions. This decrease was driven by a 31 percent decline in procedural abortions, without a corresponding increase in the use of medical abortions. Fewer than 4 percent of medical abortions each month were administered via telehealth during each month of the study period.

These findings contrast with use of other procedures across many specialties, which returned to pre-pandemic levels by mid-2020 or 2021 after hospitals and clinics began resuming normal operations. According to the authors, their study suggests that regulatory changes designed to enhance abortion access during the pandemic did not result in a major shift from in-person visits to telehealth encounters, at least among abortions reimbursed by commercial insurance.

An accompanying editorial by authors from the University of Colorado and Warren Alpert Medical School of Brown University call for internal medicine physicians, regardless of specialty, to serve as resources for their patients’ reproductive health needs. The authors note that there is an opportunity for some internal medicine physicians to prescribe abortion pills in their practice, with the support of existing resources. They add that for those physicians who are restricted from prescribing because of state laws or employer regulations, awareness of reliable local and online resources where patients can access abortion services is paramount. Finally, they argue that internal medicine physicians and professional societies should consider ways to include access to abortion in their educational activities and to advocate for policy change regarding insurance coverage, especially given unequal access with self-pay abortion costs and regional barriers.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with the lead author, Catherine Hwang, MD, MSPH, please contact Haley Bridger at [email protected].