The association of U.S. state-level abortion restrictions with medication abortion service delivery innovations during the early COVID-19 pandemic

OBJECTIVES: To assess whether state-level abortion restrictions resulted in differential uptake of innovative medication abortion practices such as changing ultrasound requirements, offering telehealth, or dispensing medications without a physical exam during the early COVID-19 pandemic. METHODS: We used data from a prospective national survey of abortion providers to assess the association between a novel index of state-level abortion hostility and adoption of medication abortion services innovations during the pandemic. RESULTS: Clinics in states with low or medium hostility were more likely to adopt innovative practices than those in high or extreme hostility states. CONCLUSIONS: Clinics in abortion hostile states were less likely to adopt clinical recommendations and public health best practices for abortion care during the COVID-19 pandemic.