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Feature Covid-19

Clinicians are leading service reconfiguration to cope with covid-19

BMJ 2020; 369 doi: (Published 09 April 2020) Cite this as: BMJ 2020;369:m1444

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Re: Clinicians are leading service reconfiguration to cope with covid-19

Dear Editor,

Reconfiguration of health services to cope with COVID-19 is ongoing also in Italy. On 25 March 2020, the Italian Ministry of Health published an update on COVID-19 guidelines for hospital preparedness. Among others, it includes i) the option to convert several facilities and hospitals into COVID-19 medical hubs and ii) plans to cancel elective and non-urgent procedures to expand hospitals’ capacity to provide critical care. The decision can also affect abortion care, increasing the risk to make the voluntary interruption of pregnancy inaccessible.

To date, pharmacologically induced abortion (Mifepristone, RU486) accounts for 17% of the total pregnancy interruption interventions performed in Italian public hospitals. The procedure requires up to three-days hospitalization for women, in order to reduce excessive uterine bleeding and infection risks associated with the abortion pill. Medical abortion is only considered an outpatient procedure in five out of 20 Italian regions, while surgical abortion is usually a one-day procedure. Therefore, RU486 does not represent the preferred choice to perform pregnancy termination, given this unjustifiable refinement of the Diagnosis-Related Group (DRG) system.

In UK the government recently approved the temporary use of abortion pills at home to avoid the risk of COVID-19 infection for women attending clinics. This leads to an unprecedent change in abortion policy of the Country
Furthermore, the World Health Organization, under specific circumstances, welcomes the self-management of the abortion pill without direct supervision of a health care provider during the first trimester. On this basis, COVID-19 pandemic imposes on the Italian healthcare system the need to: i) improve women’s access to abortion care, including the introduction of e-consultation; ii) ensure continued access to key services with early medical abortion pills delivered at home; iii) protect public safety either for women and abortion care staff avoiding unnecessary facility visits.

Competing interests: No competing interests

16 April 2020
Saverio Bellizzi
Medical epidemiologist
Benedetta Armocida, Luca Cegolon, Francesca Palestra, Antonio Manca, Giuseppe Pichierri, Silvia Ussai