Changes in the numbers of hospital‐based abortions and outpatient early medical abortions in Victoria, 2012–22: a retrospective cohort study

Abstract

AbstractObjectivesTo assess changes in the monthly numbers of hospital‐based abortions and outpatient early medical abortions in Victoria during January 2012 – March 2022, with a particular interest in the impact of the coronavirus disease 2019 (COVID‐19) pandemic.Study designPopulation‐based retrospective cohort study; time series analysis of Victorian Admitted Episodes Dataset (VAED) and Pharmaceutical Benefits Scheme (PBS) data.Setting, participantsAll admitted care episodes in Victoria during 1 January 2012 – 31 March 2022 with medical abortion as the principal diagnosis; all PBS claims for mifepristone–misoprostol (MS‐2 Step) during 1 January 2015 (date of listing) – 31 March 2022.Main outcome measuresChanges in monthly numbers (with 95% confidence intervals [CIs]) of admissions for hospital‐based and outpatient early medical abortions during the pre‐pandemic period (January 2012 – March 2020), the first full month of the COVID‐19 pandemic (April 2020), and the pandemic period (May 2020 – March 2022).ResultsThe monthly number of hospital‐based abortions declined in Victoria during the pre‐pandemic period (slope, –2.92 [95% CI, –3.45 to –2.38] per month); the rate of decline was greater during the pandemic period (slope, –5.74 [95% CI, –10.5 to –0.96] per month). The monthly number of outpatient early medical abortions increased during the pre‐pandemic period (slope, 5.94 [95% CI, 5.34–6.34] per month); it declined during the first month of the pandemic (slope, –26.4 [95% CI, –70.1 to –17.3] per month), but did not significantly change thereafter. The total monthly number of abortions during the pandemic period did not deviate markedly from the pre‐pandemic median value. The pre‐pandemic declines in monthly numbers of abortions in major city hospitals, in private hospitals, or at earlier than 14 weeks’ gestation intensified during the pandemic period. During January 2015 – March 2020, 14 634 of 103 496 abortions were outpatient medical abortions (14%); during the pandemic period, 11 154 of 33 056 abortions were outpatient medical abortions (33%).ConclusionsThe use of outpatient early medical abortion has steadily increased in Victoria since the PBS listing of mifepristone–misoprostol, which helped ensure access to abortion during the COVID‐19 pandemic. Outpatient medical abortions may eventually outnumber surgical early abortions in Victoria, but they are not always appropriate: hospitals will continue to be essential for comprehensive abortion care.