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.