Adaptations to comprehensive abortion care during the COVID-19 pandemic: case studies of provision in Bolivia, Mali, Nepal, and the occupied Palestinian territory

Figures & data

Table 1. COVID-19 pandemic restrictions in case study settings*

	Bolivia	Mali	Nepal	oPt
Dates of national lockdown	30 March–30 May 2020	26 March–9 May 2020	24 March–21 July 2020	7 March–20 July 2020
Health care restrictions and SRH legal, policy guideline changes	SRH services were restricted, prioritising COVID-19 care. Attending only emergencies, after the COVID 19 test has been performed.	Due to ongoing civil unrest and the challenges of the pandemic (e.g. the spread of COVID-19 amongst health care professionals), both of which caused sudden and sporadic closure of clinics, services were often unavailable.	Only open for emergencies	Lockdowns restricted access to SRH services, particularly long-term FP methods in governmental premises. Limited access to medical services in general, particularly during lockdowns. The COVID-19 Response Plan in the oPt created inter-agency task forces and formed new strategic relationships across the SRH and water, hygiene and sanitation (WASH) sectors

*As reported by working group of partners.

Table 2. COVID-19 safe abortion response map summaries for case study countries.

Bolivia
Organization	Ipas Ipas is a non-profit, non-governmental organisation that has been working since 1973 in more than 20 countries on three continents: America, Africa and Asia. In Bolivia, it began its activities in 1998, focusing on strengthening the capacity of women, girls and young people so that they can recognise and exercise their Sexual and Reproductive Rights. In Bolivia, Ipas provides in-person provision of information on termination of pregnancy to a largely indigenous population.
Sector	Non-governmental organisation
Area of response	Accompaniment and information provision
Description of response	A theoretical and practical training process was carried out for the agents on the use of medical abortion (Misoprostol and Mifepristone). The pandemic posed a challenge as they could not provide information in person, so they began to use social media for communication.
Mali
Organization	Population Services International (PSI) PSI’s interventions address needs in family planning; safe abortion, maternal, new-born, and child health (MNCH); HIV and sexually transmitted infections (STIs); water, sanitation, and hygiene (WASH); malaria; and primary healthcare (PHC), among others. Abortion in Mali is restricted and legal only to save the life of the pregnant person and in cases of rape and incest. Both medication abortion and surgical abortion are available for post-abortion care and pregnancy termination. Medication abortion is legal through 13 weeks gestation. PSI has trained public and private sector providers on post-abortion care and manual vacuum aspiration and distributes misoprostol.
Sector	Private-not-for-profit
Area of response	Quality assurance
Description of response	To maintain quality services and prevent COVID-19 transmission, PSI/Mali utilised WhatsApp for supportive supervision for PAC and post-abortion contraception.
Nepal
Organization	MSI Reproductive Choices
Sector	Private-not-for-profit
Area of response	CAC service delivery
Description of response	MSI Nepal worked to ensure passage of “Interim Guidelines on Reproductive, Maternal, Newborn, Child and Adolescent Health” that made is legal to provide medical abortion services outside of a certified health facility. Important new provisions include: medical abortion services allowed at home and all licenced chemists allowed to stock and dispense medical abortion products.
occupied Palestinian territory
Organization	International Planned Parenthood Federation Member Association, Palestinian Family Planning and Protection Association (PFPPA) PFPPA operate a harm reduction approach to abortion care, providing women with counselling and accurate information on the safest methods to avoid an unsafe abortion, and post-abortion care and follow-up. Prior to the pandemic, harm reduction services were provided in-person at PFPPA clinics.
Sector	Public
Area of response	Digital health interventions
Description of response	During the COVID-19 pandemic and associated lockdown restrictions that prevented women from accessing in-person services at clinics, PFPPA established a toll-free call centre which provides consultations, counselling, referrals and follow-up, including consultation for abortion care through a harm reduction approach, ensuring that women are provided with accurate information.

Table 3. In-depth interviews with key informants.

Key informant type	Nepal (n)	Mali (n)	oPt (n)	Bolivia (n)	Total
Facility manager/Access coordinator	1	1	1	1	4
Provider	2	2	2	2	8
Representative from a community or NGO that supported the adaptation	1	1	1	1	4
Total	4	4	4	4	16