Consequences of gestational age limits for people needing abortion care during the COVID-19 pandemic

As the global COVID-19 pandemic unfolds, risks to sexual and reproductive health rights have rightly been at the forefront. Abortion access, in particular, should remain essential, with the reduction of burdensome, non-evidence-based requirements, such as in-person visits for early medical abortion. The Republic of Ireland, France, and Britain (i.e. excluding Northern Ireland) have led the way in Europe since early pandemic confinement by allowing medical abortion at home via telemedicine in the first trimester. Such measures are critical to safeguard early abortion care but insufficient to address the need for later abortions, which under normal circumstances account for 10–20% of cases. With healthcare systems overwhelmed, delays in abortion care are compounded worldwide by clinic closures, provider shortages and politically motivated efforts to curtail abortion access. US and European studies demonstrate that exceeding specified gestational age (GA) limits makes travel across borders to seek care in another state or country necessary and can result in a serious burden. The pandemic has severely restrained mobility and travelling abroad (including for health reasons) has become complicated. Governments now have the option of expanding or removing GA limits and specifications (such as the number of health professionals required to sign approvals) for the provision of abortion care, which are arbitrary from public health and human rights perspectives and negatively impact the health and rights of pregnant people.