Abstract
BACKGROUND: Through an international comparison of health systems and policies, we aim at assessing the contextual and circumstantial characteristics of abortion care innovation in three European countries following the upheaval of the COVID-19 pandemic. The three contrasting care models pre-pandemic constitute an interesting baseline for observing different systems’ reaction to health crises. METHODS: We conducted a review of the recent (2020 onward) peer-reviewed and grey literature, including national policy documents and guidelines. We then carried a comparative analysis of innovations implemented during the pandemic and their sustainability post-crisis. RESULTS: In France and the UK, where abortion care was more accessible before the pandemic than in Germany, a series of innovations were officially introduced to facilitate access during the pandemic. They included teleconsultations and the mailing of abortion medication. Most changes have been sustained since then, contributing to addressing historic and systemic health inequities in terms of access (e.g. due to geography and the existence of “medical deserts”). In Germany, innovations during the pandemic have been crafted by the civil society through NGOs offering for the first time teleabortion services (e.g. Balance Berlin and Doctors for Choice). The legitimation of those practices by professional bodies is still in the making, highlighting the limitations of the catalyst role of crises in the face of cultural barriers and resistance of health systems to innovation. CONCLUSIONS: The COVID-19 pandemic provoked or accelerated innovation in terms of abortion care in France, Germany and the UK. Yet, its sustainability, as well as its scaling up, remains fragile, especially in Germany, where the disruptive approach of civil society organisations has not yet found its way into mainstream health care services. KEY MESSAGES: • International comparison of health systems’ reaction to the COVID-19 pandemic in terms of abortion care shows different paths to innovation. • The sustainability of innovation beyond the first pandemic years pertains to the wider debate on equity in access to abortion care.