The pandemic year: Research at the National Abortion Federation's 2021 Virtual Annual Meeting

The National Abortion Federation's Virtual Annual Meeting took place in May of 2021 and highlighted the work of researchers, advocates, providers, and activists who have worked tirelessly during this unprecedented year. Much of the Annual Meeting's proceedings were related to the dramatic events of the last year, both in clinical responses to the COVID-19 pandemic and in how the pandemic exposed broad inequities throughout the health care system and the effect of systemic racism and oppression on the health and lives of people seeking abortion care.

Over the last year, the COVID-19 pandemic demanded change in all aspects of health care, including abortion. As providers scrambled to respond to public health mandates to reduce the spread of the virus, they adopted evidence-based no-test abortion protocols to help people access abortion with minimal in-person contact [1]. For a brief 6 months, from July 13, 2020, to January 12, 2021, a court order blocked the in-person dispensing requirement in the mifepristone Risk Evaluation and Mitigation Strategy (REMS), allowing mifepristone by mail. Blocking the REMS made fully remote medication abortion possible in the United States. Remote medication abortion was built on a solid foundation with years of evidence, much of it presented at past NAF Annual Meetings. Although the Supreme Court reinstated the in-person dispensing requirement in the REMS in January, there is hope that with the new administration, the Food and Drug Administration will lift the REMS again during the pandemic, and then remove it for good, circumventing the need for legistlative relief and making remote provision of medication abortion care a permanent option in supportive states.

Despite the difficult year, the Annual Meeting Scientific Committee saw high-quality clinical and social science research submitted for presentation. The Committee assessed all submitted abstracts using a juried ranking process. We evaluated the abstracts for their scientific merit as well as their potential impact in the field. This issue of Contraception contains the oral abstracts presented at NAF's 2021 Annual Meeting.

1. Clinical oral abstracts

Researchers urgently documented outcomes related to no-test medication abortion. Holly Anger and colleagues conducted a prospective study comparing people who had an abortion remotely as part of Gynuity Health Project's TelAbortion Study with or without a screening ultrasound and/or pelvic exam. Ushma Upadhyay and colleagues performed a retrospective study looking at data from people provided no-test abortion at 11 sites to investigate clinical outcomes. Both studies add to the evidence that no-test abortion is safe and effective, with low rates of serious adverse events.

Alisa Goldberg and colleagues performed a retrospective cohort study of patients from Planned Parenthood League of Massachusetts to look at the abortion outcomes for people who presented with pregnancy of uncertain location who were either treated immediately or waited until pregnancy location was confirmed. As abortion takes place earlier in pregnancy, a trend supported by remote and no-test abortion, this study gives critical insight into the management of people who present before a pregnancy can be seen on ultrasound.

Finally, Matt Reeves and colleagues from DuPont Clinic presented their results from using intrafetal lidocaine injection for induced fetal demise before later abortion.

2. Social science oral abstracts

Remote abortion requires innovative patient support. Hannah Simons and colleagues from Planned Parenthood Federation of American presented the results of their study using a chat bot to support medication abortion patients. They found that patients used the chat bot widely and this subsequently reduced call volume and staff time.

Protesters are a constant source of harassment in abortion and they have been emboldened over the last year, crowding outside clinics even during the pandemic [2]. Erin Carroll and colleagues invited people seeking care at a clinic in Jackson, Mississippi, to describe the protesters’ impact on their abortion experience. Their findings support the implementation of buffer-zone ordinances carefully crafted to protect the health, humanity, and privacy of individuals accessing care.

Ushma Upadhyay and colleagues presented their investigation of abortion costs at clinics throughout the United States. They found that self-pay costs for abortion are increasing over time while the proportion of clinics that accept insurance is decreasing. Cost and coverage are major barriers to abortion access and health equity, and these barriers continue to rise.

Finally, Angel M. Foster and colleagues were able to present their abstract that was slated for last year's cancelled meeting and previously published in Contraception [3]. They interviewed former NAF Hotline workers and found that their experiences talking with people seeking abortion care transformed former Hotliners’ career trajectories and offered an opportunity to facilitate ethical abortion storytelling and advocacy.

We are grateful that we were able to gather virtually in 2021 and look forward to the day when we can see each other again in person. Thank you to all whose contributions improve the field, even in this year like no other.