Influence of the COVID-19 pandemic on abortions and births in Sweden: a mixed-methods study

Introduction Although considered an essential service by the WHO, there are indications that access to induced abortion care has been restricted during the COVID-19 pandemic. Objectives To investigate if the number of induced abortions and ongoing pregnancies changed during the first pandemic wave of COVID-19 in 2020 compared with recent years prior to the pandemic and explore possible reasons for the findings. Design Convergent parallel mixed-methods design. Collection of quantitative data from the Swedish National Board of Health and Welfare and the Swedish Pregnancy Register, and qualitative data from interviews. Setting and time period National data on abortions (January 2018-June 2020) and births (January 2018-March 2021). Interviews performed at the main abortion clinic, Gothenburg, Sweden, in June 2020. Participants All women aged 15-44 years living in Sweden 2018-2020, approximately 1.9 million. 15 women who sought abortion were interviewed. Primary and secondary outcome measures Number of abortions and births/1000 women aged 15-44 years. Themes and subthemes identified from interviews. Results The number of abortions and ongoing pregnancies did not change significantly during the study period compared with before the pandemic started. Interview themes identified were the following: meeting with abortion care during the COVID-19 pandemic (availability, and fear of being infected and infecting others); and the impact of the COVID-19 pandemic on the abortion decision (to catch COVID-19 during pregnancy, feelings of loneliness and isolation, and social aspects). Conclusions This study shows that the number of abortions and ongoing pregnancies remained unchanged during the first wave of the COVID-19 pandemic in 2020 in Sweden compared with before the start of the pandemic. Abortion-seeking women did not hesitate to proceed with the abortion. The women expressed a number of fears concerning both availability of care and their health, which could have been properly addressed by the authorities.