The impact of the coronavirus disease 2019 pandemic on abortion access and pre-abortion mental health in Shanghai

Objective To understand the barriers to abortion in Shanghai during the COVID-19 pandemic, and to compare pre-abortion mental health status before and during the crisis. Methods In this case-control study, two groups of women seeking abortion (age >= 18 years, pregnancy duration <98 days) were recruited from March to September, 2021 (n = 1070) and from February to April 2022 (n = 625). The evaluation included COVID-19-related abortion stress questions, the Symptom Checklist-90 Revised questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Family Environment Scale Chinese version. The researchers conducted interviews and collected questionnaires. Results The median pregnancy duration at abortion among women during the pandemic was 65 days, compared with 51 days in the pre-pandemic group (P < 0.001). Anxiety and depression symptoms increased during the crisis (P < 0.001). Sleep disturbances were more common. Higher PSQI scores were related to increased anxiety and depression symptoms. A more negative family climate was described during the pandemic. Conclusion During the COVID-19 pandemic, abortion access was delayed and pre-abortion mental disorders increased. More attention should be paid to the mental health of women seeking abortions, and innovations should be promoted to ensure abortion services without delay.