• Catherine S Hwang, Aaron S Kesselheim, Ameet Sarpatwari, Krista F Huybrechts, Gregory Brill, and Benjamin N Rome.
• Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (C.S.H., A.S.K., A.S., K.F.H., G.B., B.N.R.).
• Ann. Intern. Med. 2023 Nov 1; 176 (11): 150815151508-1515.

BackgroundDuring 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.ObjectiveTo estimate changes in the incidence rate of induced medical and procedural abortions.DesignSerial cross-sectional study with interrupted time-series analyses.SettingCommercially insured persons in the United States.ParticipantsReproductive-aged women.InterventionOnset of the COVID-19 pandemic in March 2020 and subsequent regulatory changes affecting the in-person dispensing requirement for mifepristone.MeasurementsMonthly 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.ResultsIn 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.LimitationOnly abortions reimbursed by commercial insurance were measured.ConclusionThe 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 SourceHealth Resources and Services Administration.

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