During this public health crisis, pregnancy care, including abortion care, remains an essential health service. As the professional association of abortion providers, NAF can provide suggestions to facilities to reduce exposure risks to patients and staff. Please contact email@example.com for questions about this information.
Abortion care is a time-sensitive service that cannot be significantly deferred without profound consequences for women and their families. Patients presenting for time-sensitive care, including abortion care, need timely access to treatment, even during this pandemic. As we navigate COVID-19, it is critical that leaders treat outpatient abortion providers as essential businesses, and that hospital systems ensure the continuation of abortion care as an essential service.
Given this crisis moment, we are providing the majority of these resources to non-members; however, if they are reprinted or used by others, they should be credited to the National Abortion Federation.
Abortion is a safe, time-sensitive procedure and it is still being provided in outpatient clinics and hospitals throughout the United States and Canada during this COVID-19 outbreak. You can find a provider in your area here. You should contact the clinic directly to confirm their operating hours during this rapidly-evolving situation. NAF member providers: Click here to access the NAF Members-Only Directory.
The NAF Hotline (1-800-772-9100) is open and operating during our normal hours: 7 am to 11 pm Eastern Monday to Friday and 9 am to 5pm Eastern Saturday and Sunday. Our Hotline Intake Counselors can answer questions about abortion and pregnancy options, help you find a quality provider, and help you with limited financial assistance if you are having trouble affording your care.
NAF Sample Guideline: Providing medication abortion with no pre-treatment testing (This guideline is only available to NAF members. To join NAF, please contact firstname.lastname@example.org)
Need to help a patient find another provider?
NAF has a directory of clinics with updated information on services and capacity to help our member clinics give patients the most accurate information on other clinics and services. This provider-facing directory is currently only available to NAF members. If you are a health care provider in need of referral information, please contact email@example.com or call our toll-free Referral Line: 1-877-257-0012.
Guidance for Abortion Providing Facilities
This situation is evolving rapidly. Please make sure you are following the most updated recommendations and check with state and local authorities. The following recommendations were current as of March 17, 2020. Please contact firstname.lastname@example.org with any questions.
- Encourage sick employees to stay home. Staff should not need a doctor’s note to excuse the absence and should return to work when they are free of symptoms for 24 hours.
- Staff who have been exposed or potentially exposed to COVID-19 should follow guidelines for assessment and monitoring. These guidelines are evolving rapidly. Please make sure you are following the most updated recommendations and check with state and local authorities about the need for monitoring or restriction of activities.
- Encourage proper cough and sneeze etiquette. Have tissues available and no-touch disposal.
- Clean and disinfect high touch areas frequently. Waiting room and patient areas should be disinfected more frequently than at the end of the day.
- Encourage staff to use alcohol-based hand sanitizer often and wash with soap and water when visibly soiled or after using hand sanitizer six times.
- Staff must use gloves for all patient interactions. Change gloves and wash hands between patients.
- Front desk staff can wear gloves while taking payment or exchanging clipboards and pens with patients. Give front desk staff wipes and time to use them between patient check-ins.
- When providing food for staff, do not serve buffet-style food with shared utensils. Provide single-serve food in separate containers.
- Review all sick and leave policies. Ensure policies are flexible to allow for personal illness, caregiving, or the need to provide child care during school closures.
- Check that employee assistance programs have resources for staff who may be experiencing stress due to the COVID-19 outbreak.
- Consider staffing options if staff are absent due to illness, caregiving, school closures, or travel restrictions. Consider cross-training staff, extending hours, or hiring temporary staff (subject to the careful vetting always necessary for temporary staff). Understand minimum staffing requirements for patient care.
- Connect with area providers to create a backup plan for patient referrals if the clinic needs to close.
- Consider limiting large staff gatherings, for example, holding virtual rather than in-person all staff meetings.
- For staff who are able, provide the tools needed for telework.
- Monitor state Department of Public Health and Board of Medicine websites for up to date information about expedited licensing and remote or telehealth service delivery.
Clinics should review their clinical practices to minimize patient-patient and patient-staff contact.
- Screen patients for symptoms of acute respiratory illness (fever, cough, difficulty breathing) BEFORE entering the facility (for example, during the phone screen or with the security guard). Reschedule for when they are well.
- Post signs in the waiting room that ask patients to reschedule if they are experiencing fever or cough. Have patients who are coughing wear a mask. Have hand sanitizer, tissues, and no-touch disposal available in all patient areas.
- If possible, consider not scheduling patients in “blocks”, that is, having multiple patients show at the same appointment time. Space patient appointments so the waiting room is not full.
- Consider a flow that minimizes patient-patient and patient-staff contact. For example, a patient can be placed in a room, and then labs, education, and ultrasound can come to the patient rather than moving the patient in and out of different rooms via an internal or external waiting room.
- Reconsider whether “routine” labs are needed, for example, urine testing if ultrasound is already being performed. Refer to NAF’s Clinical Policy Guidelines for Abortion Care for more information about which labs are necessary for abortion care. Most early abortion patients do not need any testing at all.
- Do not refill patient cups. Get a new disposable cup each time a patient needs a drink.
- Shift patient care to remote or phone rather than in-person as much as possible.
- Extend patient prescriptions without an in-person visit.
- Have patients fill out screening forms at home and email them or bring them to their clinic visit, rather than filling them out in person.
- Consider whether patient education and consent can be done over the phone rather than in person.
- Use remote rather than in-person medication abortion follow-up (for example, use labs or a phone call and symptom checklist rather than an ultrasound).
- In areas with community spread, reschedule all non-essential visits.
- Have patient escorts wait outside for patients or call them when the patient is ready for discharge. Reevaluate the presence of support people in patient areas.
Infection prevention resources for clinics
Webinars - Listen to NAF's COVID-19 Webinar Series
Webinar Recording: One-day Provision of Second-Trimester Abortion Using a Foley Catheter for Cervical Preparation This recording is available for NAF members only through our members-only website here (please do not share this recording with non-NAF members). If you have questions or would like to join NAF, contact us at email@example.com.
Webinar Recording: Preventing Transmission of COVID-19 in the Abortion Care Setting
Lisa Spacek, MD, PhD; Associate Professor in the Division of Infectious Diseases at Thomas Jefferson University on 3/24/20. Please note that CDC updates guidelines regularly; please visit cdc.gov.
These are some of the more frequent questions we have been asked. Guidance related to COVID-19 exposures among health care workers is taken from the Centers for Disease Control, whose guidance changes rapidly. Please see CDC.gov for the latest guidance or contact your local department of health. Please send any questions or requests to firstname.lastname@example.org.
According to the American College of Surgeons, aspiration abortion, D&C, and D&E are not aerosol generating procedures. Therefore, these procedures do not require full PPE, including an N95 respirator. Abortion providers should screen patients prior to the procedure and use standard precautions. For more information about aerosol generating procedures, please click here.
Home-sewn masks or cloth face coverings are not a replacement for surgical masks. However, cloth face coverings can be used to extend the supply of surgical masks. Surgical masks should be reserved for priority activities where exposure is expected such as abortion procedures, tissue processing, instrument processing, or prolonged face-to-face contact with patients. During these activities, cloth face coverings are a last resort and should ideally be paired with a face shield that covers the entire front and sides of the face. Cloth face coverings can be used by security, administrative, or front desk staff; clinic escorts; patients; or patient support people. Giving patients and patient support people a clean cloth mask on entry to the facility and then collecting it when they leave and washing the mask may protect other patients and staff from asymptomatic transmission when community transmission is widespread. For more information on face masks, please review the CDC information here.
Given widespread community transmission, it is very likely that staff members and patients may become sick. What to do next depends on balancing the likelihood of other staff being exposed and the desire to maintain patient access. Because the recommendations are updated frequently, please visit CDC.gov or contact your local department of health for assistance in deciding whether to exclude contacts from work.
First, evaluate whether your staff had exposure that could potentially transmit the virus to them. Were staff present when the sick staff member or patient was sick and coughing? Were the sick person and healthy staff members wearing masks when interacting? Depending on the risk of transmission, staff either need to be excluded from work for 14 days after the last exposure or can monitor themselves and return to work. The risk of transmission depends on the length and type of contact as well as whether the person with the infection and the person exposed were wearing masks. Brief interactions like a conversation at a triage desk, are considered low risk even without masks. For more information, please see the section II and Table 1 in the middle of this page for guidance.(3)
Second, evaluate whether excluding exposed staff from work will affect the clinic’s ability to provide services. According to the CDC’s website, “facilities could consider allowing asymptomatic health care personnel who have had an exposure to a COVID-19 patient to continue to work after options to improve staffing have been exhausted and in consultation with their occupational health program.” Facilities may ask exposed staff to wear a mask for 14 days and report on any symptoms. Staff who develop even mild symptoms of COVID-19 should immediately stop patient care activities.
COVID-19 testing is not recommended for asymptomatic patients before an abortion procedure. COVID-19 testing adds delays and cost to an abortion procedure with no benefit to the patient.
COVID-19 testing availability and recommendations in the United States vary from state to state and region to region. There are currently not enough tests available in many areas even for those who need them, including symptomatic individuals, individuals with potential exposures, and essential workers. Available testing is often distributed through a health department and prioritized in larger public health facilities, hospitals, and labs, and not smaller facilities like abortion clinics.
The risk of COVID-19 transmission during an outpatient abortion procedure is low. Abortion is a non-aerosol generating procedure and the need for intubation or airway management is rare. Facilities currently screen all patients prior to entry by checking for signs, symptoms, and risk factors for COVID-19 infection. Facilities are currently taking precautions against transmission by practicing social distancing, minimizing pre-abortion testing, requiring masks, and using appropriate personal protective equipment. Although asymptomatic individuals may be carrying the virus, the role asymptomatic individuals play in transmission is not well understood.
Abortion is a time-sensitive service that cannot be significantly deferred without profound consequences for women and their families. If a facility does not have tests, patients may need to go elsewhere, may need to pay out of pocket, and results may take days to return. Because testing adds delays and cost with no proven benefit to the patient or the health care facility and staff, testing asymptomatic patients for COVID-19 before abortion is a barrier to abortion access and is not recommended.
 Gokhale P, Lappen JR, Waters JH, Perriera LK. Intravenous sedation without intubation and the risk of anesthesia complications for obese and non-obese women undergoing surgical abortion: a retrospective cohort study. Anesth Analg. 2016;122(6):1957-62. https://doi.org/10.1213/ANE.0000000000001335.
Fentanyl can be replaced with other opioid analgesics, including morphine, meperidine (Demerol®), and hydromorphone (Dilaudid®). You can also use opioid agonist-antagonists or partial agonists like butorphanol (Stadol®) and nalbuphine (Nubain®), although these medications should be used with caution in areas with high rates of opioid use or medication assisted treatment for substance use disorder. Be aware that opioids have different onset and half-life and patient response and recovery may take longer. For an external reference for opioid analgesic equivalents, please click here.