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Objective: To understand the COVID‐19 pandemic's impact on abortion care‐seeking in Maryland, a state with Medicaid coverage for abortion, high service availability, and laws supporting abortion rights. Methods: We conducted semi‐structured telephone interviews with 15 women who had an abortion between January 2021 and March 2022 at a hospital‐based clinic in a mid‐sized Maryland city. We purposively recruited participants with varied pandemic financial impacts. Interview questions prompted participants to reflect on how the pandemic affected their lives, pregnancy decisions, and experiences seeking abortion care. We analyzed our data for themes. Results: All participants had some insurance coverage for their abortion; over half paid using Medicaid. Many participants experienced pandemic financial hardship, with several reporting job, food, and housing insecurity as circumstances influencing their decision to have an abortion. Most women who self‐reported minimal financial hardship caused by the pandemic indicated they sought an abortion for reasons unrelated to COVID‐19. In contrast, women with economic hardship viewed their pregnancies as unsupportable due to COVID‐19 exacerbating financial instability, even when they desired to continue the pregnancy. All participants expressed that having an abortion was the best decision for their lives. Yet, when making decisions about their pregnancy, the most financially disadvantaged women weighed their desires against the pandemic's constraints on their reproductive self‐determination. Conclusions: The pandemic changed abortion care‐seeking circumstances even in a setting with minimal access barriers. Financial hardship influenced some women to have an abortion for a pregnancy that—while unplanned—they may have preferred to continue. [ABSTRACT FROM AUTHOR]

Objectives: This exploratory study aimed to assess COVID‐19‐related changes in abortion service availability and use in Washington, DC, Maryland, and Virginia. Design: Data came from a convenience sample of eight abortion clinics in this region. We implemented a cross‐sectional survey and collected retrospective aggregate monthly abortion data overall and by facility type, abortion type, and patient characteristics for March 2019–August 2020. We evaluated changes in the distribution of the total number of patients for March–August in 2019 compared to March–August 2020. We also conducted segmented regression analyses and produced scatter plots of monthly abortion patients overall and by facility type, abortion type, and patient characteristics, with separate fitted regression lines from the segmented regression models for the pre‐ and during‐COVID‐19 periods. Results: Five clinics reported a reduced number of appointments early in the pandemic while four reported increased call volume. There were declines in the monthly abortion trend at hospital‐based clinics at the outset of the pandemic. Monthly number of medication abortions increased from March 2020 through August 2020 compared to pre‐COVID‐19 trends while instrumentation abortions 11 up to 19 weeks decreased. The share of abortions to Black individuals increased during the early phase of the pandemic, as did the monthly trend in abortions among this group. We also saw changes in payment type, with declines in patients paying out‐of‐pocket. Conclusions: Results revealed differences in abortion services, numbers, and types during the early stages of the COVID‐19 pandemic in Washington, DC, Maryland, and Virginia. [ABSTRACT FROM AUTHOR]

Context: Many people wanted to avoid or delay childbearing during the COVID‐19 pandemic. This study sought to examine the extent COVID‐19 influenced abortion care‐seeking in a region that did not enact policy restricting abortion due to the pandemic, has high service availability, and few abortion‐restrictive policies. Methodology: We conducted telephone surveys with adults (n=72) requesting abortion appointments between September 2020 and March 2021 at five clinics in Washington, DC, Maryland, and Virginia. We used χ2 tests to compare sociodemographic, reproductive history, service delivery characteristics, and pandemic‐related life changes by whether COVID‐19 influenced abortion care‐seeking. Results: Most respondents (93%) had an abortion at the time of the survey, 4% were awaiting their scheduled appointment, and 3% did not have an appointment scheduled. Nearly 40% of people reported COVID‐19 influenced their decision to have an abortion. These individuals were significantly more likely to report "not financially prepared" (44% vs. 16%) as a reason for termination compared to people reporting no influence of COVID‐19. They were also more likely to have lost or changed their health insurance due to pandemic‐related employment changes (15% vs. 2%), report substantial money difficulties due to COVID‐19 (59% vs. 33%), and report that paying for their abortion was "very difficult" (25% vs. 2%). Conclusion: COVID‐19 influenced many people to have an abortion, particularly those financially disadvantaged by the pandemic. Expansion of Medicaid abortion coverage in Washington, DC and Virginia could reduce financial barriers to care and help people to better meet their reproductive needs amid future crises. [ABSTRACT FROM AUTHOR]