Abortions declined after COVID-19 pandemic despite regulatory waiver

Key takeaways:

• The monthly incidence rate of abortions dropped from 151 per 1 million in 2018 to 20 per 1 million in 2020.
• Physicians have an opportunity to become a trusted source for abortion services, experts said.

The overall incidence rate of abortions reimbursed through commercial insurance decreased 14% during the early stage of the COVID-19 pandemic despite eased regulations, and it did not return to pre-pandemic levels, a recent study found.

According to Catherine S. Hwang, MD, MSPH, an internal medicine physician at Brigham and Women’s Hospital and Harvard Medical School, and colleagues, the in-person visit requirement for mifepristone was waived from July 2020 to January 2021 and after April 2021, “creating an opportunity for increased patient access to medical abortions via telehealth.”

However, it was unknown how the regulatory changes impacted abortion rates or were communicated to providers across the country, the researchers wrote in the Annals of Internal Medicine.

So, Hwang and colleagues evaluated medical and procedural abortion incidence rates among girls and women aged 15 to 44 years from January 2018 to June 2022.

There were 9,889 medical abortions and 7,623 procedural abortions during the study period.

In January 2018, the incidence rate of abortions was 151 per 1 million women. That decreased to 21 per 1 million women after March 2020 — a reduction of 14%.

The researchers noted this drop was driven by a 31% decline in procedural abortions without a corresponding increase in the use of medical abortions.

Although the use of telehealth abortions increased slightly during the pandemic, telehealth abortions still accounted for less than 4% of medical abortions in each month of the study period, according to the researchers.

Hwang and colleagues said there were several possible explanations for the findings, one of which being that more women with commercial insurance received abortion care through self-pay methods after the pandemic.

“In the wake of regulatory changes regarding the in-person dispensing requirement for mifepristone, several online mail order services (most of which do not accept insurance) began offering telehealth abortions,” they wrote. “Our study suggests that telehealth adoption is insufficiently widespread to meaningfully increase access to abortion care among those with commercial insurance coverage.”

In a related editorial, Jennifer L. Michener, MD, an assistant professor of medicine and internal medicine at the University of Colorado School of Medicine, and Mindy Sobota, MD, MS, MPhil, FACP, an associate professor of medicine at Brown University, explained that as internal medicine physicians, “we should inquire about “patients’ reproductive health needs and serve as a trusted resource for our patients seeking abortion.”

Michener and Sobota pointed out there are opportunities for physicians to prescribe abortion medication in their practices with the help of existing resources.

“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,” they wrote. “Internal medicine physicians and professional societies should consider ways to include abortion in their educational activities and to advocate policy change regarding insurance coverage, especially given unequal access with self-pay abortion costs and regional barriers.”

References:

• Hwang C, et al. Ann Intern Med. 2023;doi:10.7326/M23-1609.
• Michener J, Sobota M. Ann Intern Med. 2023;doi:10.7326/M23-2582.