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The COVID-19 pandemic’s effect on access to abortion care

Independent abortion clinics have experienced considerable challenges due to COVID-19 and the general public health response. In some regions, politicized responses to the pandemic and pre-existing restrictive abortion policies worsened these challenges. More clinics in the South and Midwest than the Northeast and West reported having had to temporarily close their clinics and having to cancel or postpone abortion services.

Key Findings

The COVID-19 pandemic and the general public health response to the COVID-19 pandemic — such as quarantine requirements, school closures and travel restrictions — affected the abortion care delivery system.
Half of independent clinics in all regions reported having a clinician or staff member unable to work due to the pandemic itself or the general public health response to the pandemic.
Fewer clinics in the Northeast (5%) and West (5%) reported having to temporarily close their clinic than respondents in the Midwest (21%) and South (35%).
Most clinics in all regions reported having to cancel or postpone at least some clinical care services, most commonly non-abortion gynecologic services.
38% canceled or postponed at least some 1st-trimester aspiration abortions, 27% did so with 2nd-trimester abortion services.
In open-ended responses, clinics also described logistical challenges, the steps they were taking to protect health, common stressors and buffers presented by state laws and the local community, shifts in the workforce, heightened emotions, cost increases

Study Design 

Between April 16, 2020 and May 22, 2020, researchers recruited 103 independent abortion providers to participate in a brief online survey about how COVID-19 affected their abortion clinic. The team sought one respondent per each clinic who could describe experiences there. Respondents were asked a series of closed-ended questions along with two open-ended questions to allow them to describe how else COVID-19 has affected their clinic and the services they were able to provide.

Regardless of the region in which clinics are located, independent abortion clinics have been affected by the COVID-19 pandemic and the general public health response. Clinics have had to cancel and postpone health services, including abortion care, and have made substantial changes to their work schedules and clinic flow procedures.

Although healthcare providers have faced challenges across the board, the study found that abortion clinics and patients in the South and, in some cases, the Midwest, have also been affected by politicized responses to COVID-19 (such as declarations of abortion as a non-essential service) and pre-existing restrictive abortion policies. Pre-existing restrictive abortion policies, such as laws mandating in-person counseling and laws banning telemedicine for abortion, impeded their ability to adopt some of the clinic flow and clinical innovations that they otherwise would have implemented in response to the pandemic.

Because of the brief time period in which surveys were conducted, these findings should be viewed as the floor, rather than the ceiling, in terms of the number of clinics that have had these experiences.

Going forward, there remains a need for additional research to understand the impact that abortion service delays and clinic closures have on patients, particularly in the South and Midwest. Additional research should aim to assess whether any clinics have closed permanently as a result of the pandemic, the general public health responses to the pandemic, or the politicized responses to the pandemic. Public health officials might also consider including abortion clinics in their efforts to plan around pandemic responses in the future.

“What is remarkable … is that despite all of these significant challenges, the overwhelming majority — more than 80% — of our sample indicated that they remained open and were able to continue to provide abortion care throughout the early weeks of the pandemic in the U.S. This resiliency and commitment to patients among the abortion providers we surveyed is consistent with findings from previous research with abortion providers.”

This study, COVID‐19 and Independent Abortion Providers: Findings from a Rapid‐Response Survey, is available in Perspectives on Sexual and Reproductive Health.