Hwang CS, Kesselheim AS, Sarpatwari A, Huybrechts KF, Brill G, Rome BN. Changes in Induced Medical and Procedural Abortion Rates in a Commercially Insured Population, 2018 to 2022 : An Interrupted Time-Series Analysis.
Ann Intern Med 2023;
176:1508-1515. [PMID:
37871317 DOI:
10.7326/m23-1609]
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Abstract
BACKGROUND
During the COVID-19 pandemic, access to in-person care was limited, and regulations requiring in-person dispensing of mifepristone for medical abortions were relaxed. The effect of the pandemic and accompanying regulatory changes on abortion use is unknown.
OBJECTIVE
To estimate changes in the incidence rate of induced medical and procedural abortions.
DESIGN
Serial cross-sectional study with interrupted time-series analyses.
SETTING
Commercially insured persons in the United States.
PARTICIPANTS
Reproductive-aged women.
INTERVENTION
Onset of the COVID-19 pandemic in March 2020 and subsequent regulatory changes affecting the in-person dispensing requirement for mifepristone.
MEASUREMENTS
Monthly age-adjusted incidence rates of medical and procedural abortions were measured among women aged 15 to 44 years from January 2018 to June 2022. Medical abortions were classified as in-person or telehealth. Linear segmented time-series regression was used to calculate changes in abortion rates after March 2020.
RESULTS
In January 2018, the estimated age-adjusted monthly incidence rate of abortions was 151 per million women (95% CI, 142 to 161 per million women), with equal rates of medical and procedural abortions. After March 2020, there was an immediate 14% decrease in the monthly incidence rate of abortions (21 per million women [CI, 7 to 35 per million women]; P = 0.004), driven by a 31% decline in procedural abortions (22 per million women [CI, 16 to 28 per million women]; P < 0.001). Fewer than 4% of medical abortions each month were administered via telehealth.
LIMITATION
Only abortions reimbursed by commercial insurance were measured.
CONCLUSION
The incidence rate of procedural abortions declined during the COVID-19 pandemic, and this lower rate persisted after other elective procedures rebounded to prepandemic rates. Despite removal of the in-person dispensing requirement for mifepristone, the use of telehealth for insurance-covered medical abortions remained rare. Amid increasing state restrictions, commercial insurers have the opportunity to increase access to abortion care, particularly via telehealth.
PRIMARY FUNDING SOURCE
Health Resources and Services Administration.
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