[Innovation in abortion care during the COVID-19 pandemic in Germany, France and Great Britain : Paths to maintaining access and building system resilience].

The COVID-19 pandemic has had a drastic impact on healthcare systems. They had to react, adapt and innovate in order to build resilience, that is maintain healthcare access and health equity. For example, access to abortion services during the pandemic was increasingly facilitated through "Telehealth for Early Medical Abortion" (TEMA).This narrative review article compares Germany, France and Great Britain in terms of abortion numbers, methods and settings from 2018 to 2023. Changes in the availability of services and legislation during the pandemic are presented, and the differences between the countries, as well as various innovation factors, are discussed. We used national statistics and conducted a literature and online search (Rapid Review).In the three countries, there are differences in abortion rates, the share of medical abortions and the impact of the pandemic. In France and Great Britain, where medical abortion is the main method of abortion and where abortion care was more accessible before the pandemic than in Germany, a series of innovations were officially introduced to facilitate access during the pandemic. They included teleconsultations and the mailing of abortion medication. Most changes have been sustained since then, contributing to addressing historic and systemic health inequities in terms of access. In Germany, innovations during the pandemic have been crafted mainly by civil society organisations, offering for the first time teleabortion services.The COVID-19 pandemic provoked or accelerated innovation in terms of abortion care in France, Germany and Great Britain. The sustainability and scaling-up of those innovations remain fragile, especially in Germany, where the disruptive approach of civil society organisations has not yet found its way into mainstream healthcare services.