Table 1.

Changes to abortion services (mostly related to medical abortion*) instituted in 10 European countries in the context of COVID-19

Country	Changes	Regulatory process and date of implementation	Assessment of changes: permanent or temporary
Belgium	Changes in abortion care during COVID-19 depended on facility type and region. While outpatient abortion centres (84% of abortions in Belgium) continued to provide regular abortion care, some hospitals stopped offering abortion care or reduced facility-based abortion by ○ promoting medical abortions up to 9 weeks+6 days with home use of misoprostol ○ referring later abortions to outpatient abortion centres, French-speaking abortion centres promoted medical abortion up to 8 weeks with misoprostol at home (with phone supervision). Flemish abortion centres provided the first consultation online with a one-step visit for surgical abortion after the mandatory 6-day waiting period (nearly no medical abortions).	Recommendations were not endorsed by the government’s Department of Health but were implemented by abortion centres in mid-March (1 week after lockdown)	Unsure
Estonia	Fewer visits to clinic. Remote consultation (usually by phone). Use of misoprostol at home is encouraged (available before COVID 19).	Recommendations by Estonian Society of Gynaecologists and Clinicians not officially approved	Some changes will be permanent
Finland	Home use of misoprostol extended up to 10 weeks+0 days (previously 9 weeks+0 days) in Helsinki.	Change in local practice	Temporary but possibly to become permanent
France	Gestational limit of medical abortion at home raised from 7 weeks to 9 weeks+0 days. Medical abortions all performed by telemedicine without mandatory in-person consultation. Pharmacy access to mifepristone and misoprostol through a medical order directly sent to the pharmacy by the provider.	Guidelines by National Society (CNGOF) 26 March 2020 Guidelines by National Health Agency 10 April 2020 Law 15 April 2020	Upper limit of 9 weeks gestation may be permanent, other measures temporary
Germany	Mandatory counselling can be performed via telemedicine, but most abortions are performed surgically (very small number of medical abortions).	Ministry No official guidelines for abortion	Unsure
Hungary	In the public sector, surgical abortions (only method available in Hungary) were ceased, as a result of the government ban on non-life-saving procedures. With the closing of most of the private clinics during the pandemic, abortion was unavailable in the private sector.	Officially, no change	Temporary
Ireland	Remote consultation with a medical practitioner for medical abortion, with face-to-face consultations only in exceptional circumstances. Both mifepristone and misoprostol are taken at home up to 9 weeks. Informed consent may be obtained verbally or by confirmatory email from the patient to the doctor. The guidance states that arrangements must be made for the collection of medical abortion medications. The need to administer anti-D to a patient with a Rhesus-negative blood group whose pregnancy is less than 9 weeks' gestation was suspended.	Revised Model of Care for Termination in Early Pregnancy issued by the Health Service Executive and Department of Health on 7 April 2020	Temporary
Norway	Introduction of non-facility-based abortion by allowing gynaecologists outside of hospitals to conduct abortion up to 12 weeks’ gestation (pre-COVID, abortions were only facility-based).	Decision by the Directorate of Health	Temporary
Portugal	Omit the waiting period. Only one visit with a doctor for ultrasound and abortion. Postponement of follow-up visit when possible or follow-up visit by telemedicine.	Recommendations by Portuguese Society of Contraception and Clinicians not officially approved but implemented by Obstetrician Services	Temporary
Switzerland	Some clinics have extended the gestational age limit for medical abortion from 7 to 9 weeks due to difficulties accessing surgical abortion.	Recommendations were not officially approved	Unsure
UK (Wales and England)	Use of telemedicine and approval for home use of both mifepristone and misoprostol up to 9+6 weeks as per guidelines. The new guidelines support non-use of ultrasound at this gestation for example if LMP is certain and no significant risk of ectopic pregnancy. Approval for home use includes postal delivery of medication.	Department of Health of the Wales Government on 31 March 2020 Department of Health of the English Government on 30 March 2020	Unsure
UK (Scotland)	Use of telemedicine and approval for home use of both mifepristone and misoprostol up to 11 weeks+6 days as per Scottish guidelines. The new guidelines support non-use of ultrasound at this gestation, for example, in the case LMP is certain and there is no significant risk of ectopic pregnancy. Approval for home use includes postal delivery of medication. The need to administer anti-D to a patient with a Rhesus-negative blood group having medical abortion at 10–12 weeks has been suspended.	Department of Health of the Scottish Government on 30 March 2020	Unsure
UK (Northern Ireland)	Abortion services started to operate in April 2020 for first-trimester abortions. Use of misoprostol at home currently up to 10 weeks.	The provision of abortion services following Northern Ireland’s October 2019 legislation was implemented by the Department of Health of the Northern Ireland Government on 9 April 2020	Permanent

*In Europe, medical abortion is performed using mifepristone followed by misoprostol.

LMP, last menstrual period.