By Dr Karin Brandell
In Italy, abortion is legal up to 90 days of pregnancy but with restrictions that pose barriers to the service, including widespread conscientious objection and an obligatory waiting period of 7 days. Italy was one of the first countries hit by the COVID-19 pandemic, with multiple restrictions imposed on the public (for example, strict lockdown measures and travel restrictions) that could further affect access to reproductive health services. In our study ‘Telemedicine as an alternative way to access abortion in Italy and characteristics of requests during the COVID-19 pandemic’, we examined the demand for telemedicine abortion before the pandemic and how it changed during the first 9 months of the pandemic. We analysed requests from Italy to the online abortion provider Women on Web (WoW) and also looked specifically at teenagers’ requests.
We saw that even before the pandemic there was a demand for self-managed abortion from women living in Italy (377 requests between March and December 2019). However, this drastically increased during the first 2 to 3 months following the first national lockdown and saw a total increase of 12% (n=390) during the first 9 months of the pandemic. In 2020, half of the requests stated the pandemic had made it difficult for women to access abortion. In total, the most common reason for contacting WoW regarding self-managed abortions were privacy-related issues. However, this reason was less pronounced for requests made during the COVID-19 pandemic and even less so when looking at requests from women who specified COVID-19 as a barrier to abortion.
Analysing requests from teenagers suggested a more vulnerable situation with presentation of pregnancies at later gestations (85.9% in 7-10 weeks), higher prevalence of rape (10%), economic and social difficulties as well as stigma, and lower utilisation of healthcare services such as pregnancy tests and ultrasounds compared to adult women. Comparison of responses from teenagers before and during the pandemic was not performed due to the small group size of analysed teenage pregnancies.
Our study highlights barriers to abortion in a high-income country where abortion is legal and we could see that the reasons for requesting an abortion changed during the pandemic, shifting from privacy-related to COVID-19-specific reasons during the pandemic. The findings are in line with previous studies that support the World Health Organization recommendation for increasing access to induced abortion through telemedicine, especially important during the pandemic, and the FIGO statement that supports telemedicine provision beyond the pandemic.
Karin Brandell, MD, is a resident in Obstetrics and Gynaecology at Södertälje Hospital and a PhD-student at Karolinska Institutet, Stockholm, Sweden. Her research focuses on increasing access to medical abortion both in very early gestation and via telemedicine.