Changes in the numbers of hospital-based abortions and outpatient early medical abortions in Victoria, 2012-22: a retrospective cohort study

Objectives: To assess changes in the monthly numbers of hospital-based abortions and outpatient early medical abortions in Victoria during January 2012 – March 2022, with a particular interest in the impact of the coronavirus disease 2019 (COVID-19) pandemic. Study design: Population-based retrospective cohort study; time series analysis of Victorian Admitted Episodes Dataset (VAED) and Pharmaceutical Benefits Scheme (PBS) data. Setting, participants: All admitted care episodes in Victoria during 1 January 2012 – 31 March 2022 with medical abortion as the principal diagnosis; all PBS claims for mifepristone–misoprostol (MS-2 Step) during 1 January 2015 (date of listing) – 31 March 2022. Main outcome measures: Changes in monthly numbers (with 95% confidence intervals [CIs]) of admissions for hospital-based and outpatient early medical abortions during the pre-pandemic period (January 2012 – March 2020), the first full month of the COVID-19 pandemic (April 2020), and the pandemic period (May 2020 – March 2022). Results: The monthly number of hospital-based abortions declined in Victoria during the pre-pandemic period (slope, –2.92 [95% CI, –3.45 to –2.38] per month); the rate of decline was greater during the pandemic period (slope, –5.74 [95% CI, –10.5 to –0.96] per month). The monthly number of outpatient early medical abortions increased during the pre-pandemic period (slope, 5.94 [95% CI, 5.34–6.34] per month); it declined during the first month of the pandemic (slope, –26.4 [95% CI, –70.1 to –17.3] per month), but did not significantly change thereafter. The total monthly number of abortions during the pandemic period did not deviate markedly from the pre-pandemic median value. The pre-pandemic declines in monthly numbers of abortions in major city hospitals, in private hospitals, or at earlier than 14 weeks’ gestation intensified during the pandemic period. During January 2015 – March 2020, 14 634 of 103 496 abortions were outpatient medical abortions (14%); during the pandemic period, 11 154 of 33 056 abortions were outpatient medical abortions (33%). Conclusions: The use of outpatient early medical abortion has steadily increased in Victoria since the PBS listing of mifepristone–misoprostol, which helped ensure access to abortion during the COVID-19 pandemic. Outpatient medical abortions may eventually outnumber surgical early abortions in Victoria, but they are not always appropriate: hospitals will continue to be essential for comprehensive abortion care.