Impact of COVID-19 among women seeking abortion services in Nepal: results from a longitudinal study.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted health and well-being worldwide, but limited evidence exists on its effects on women seeking reproductive health services. This paper examined the reported prevalence of COVID-19 signs/symptoms among the women who sought abortion services and the impact pandemic had on women who either received or were denied abortion services over a 3.5-year period in Nepal.

Methods: This paper draws on data from a longitudinal study involving 1,832 women who sought abortions at 22 health facilities across Nepal between 2019 and 2020. Participants were interviewed at the time of enrollment, then again at 6 weeks, and every 6 months over a three- and a half-year period. For the analysis, data from 1,739 women were used to examine trends in the prevalence of COVID-19 symptoms and assess the broader impact of the pandemic. To evaluate the effects of COVID-19 pandemic over time, the study period was divided into 6-month intervals. Both bivariate analyses and multivariate regressions were employed to assess the pandemic's impact on these women, considering overall trends as well as differences between those who received abortions and those who were denied.

Results: Approximately three-quarters of the respondents reported some impact of COVID-19 pandemic between March and August 2020. Following another peak in March-August 2021 (71% reporting impacts), experience of pandemic impacts decreased steadily to 26% by the end of the study period (Mar-Jun 2023). Economic disruptions related to work or business were the most common impact reported followed by impacts on children's education and the inability to access or afford basic food or necessities After adjusting for baseline differences, women who gave birth after being denied an abortion were more affected by the pandemic when it came to affording daily necessities (OR = 1.78, p < .01) and accessing reproductive (OR = 2.59, p < .01) and non-reproductive health services (OR = 3.07, p < .01).

Conclusion: The study highlights the increased vulnerability of pregnant women, particularly those seeking abortion care, during the COVID-19 pandemic. The findings emphasize the critical importance of maintaining access to essential reproductive health services, such as abortion, especially during disease outbreaks and humanitarian crises. Ensuring the continuity of these services should be a top priority, and health systems must be strengthened to deliver them without disruption in future emergencies.