Abortion is healthcare. Let’s ensure it’s safe.

Posted 28 Sep 2020

Date: 28 Sep 2020

Author: Julia Hogan

To mark this year’s International Safe Abortion Day, Julia Hogan from Marie Stopes UK takes stock of the progress that has been made in access to safe abortion care so far, including through the recent introduction of telemedicine in the UK, while calling on the government to make safe access possible, by ensuring women can access services free from harassment outside of UK clinics.

This International Safe Abortion Day, we are calling for all women and pregnant people to be free to make their own decisions about their bodies.

In the UK, abortion care continues to be the only form of healthcare with criminal penalties of life imprisonment, and where team members and clients are regularly harassed outside of clinics for simply delivering or accessing a legal healthcare service. Across MSI’s global programmes, we see the impact of barriers to safe abortion access daily, with unsafe abortion taking the lives of an estimated 22,000 people every year, worldwide.

To mark this year’s safe abortion day, we would like to take stock of the progress that has been made in access to safe abortion care, including through the recent introduction of telemedicine in the UK. We call on the government to ensure that no one is left behind and deterred from accessing a service via a safe route, due to the stigma that shrouds the criminality of abortion care in the UK and the protests and harassment that surround our clinics and those of our partners.

A Catalyst for Change? Telemedicine under COVID-19

At the start of the pandemic, access to safe abortion care was under threat. Lockdowns were leaving the nation home-bound and we could see from the rise in calls to our UK safeguarding team, that reports of domestic violence were on the rise.

To protect access to timely abortion care safely, Marie Stopes UK partnered with the Royal College of Obstetricians and Gynaecologists (RCOG) and others to work with government to implement telemedicine, enabling women to have phone or video consultations and self-administer medical abortion drugs in the privacy of their own home. Telemedicine can prevent time-sensitive procedures from being delayed and reduces the risk of COVID-19 exposure for clients and staff. We also know from the WHO, RCOG, NICE and others that telemedicine has been found to be just as safe and effective as medical abortion administered at a facility.

Feedback from our Marie Stopes UK programme, which has provided over 9,600 women with medical abortions via telemedicine since April, shows that it is well received by both clients and providers, with 98% of clients rating their experience as good (14%) or very good (84%). Telemedicine also poses a unique opportunity to support the most marginalised, including women at risk of violence who might otherwise face challenges accessing care and support. By enabling women seeking an early medical abortion to take both sets of abortion pills at home, vulnerable women, including those with a coercive partner, are now able to access care more discretely. One telemedicine client, Sylvie shared that her experience of accessing a medical abortion via telemedicine was “respectful”, “compassionate” and, crucially for her, “private”.”

At MSI, we are now sharing learnings from our UK programme to roll out similar telemedicine models across our global country programmes, for example, in South Africa, Nepal and India. With India facing a particularly restrictive lockdown, telemedicine provides an opportunity to re-establish safe access, preventing women from resorting to unsafe abortion attempts.

Protecting access to facility-based abortion care, safely

It is vital to remember that medical abortion via telemedicine is not a panacea. For those seeking an abortion at later stages of pregnancy, or, as we see often in MSI’s global programmes, for those facing complications from a previous unsafe abortion attempt, access to facility-based care remain essential.

At the end of 2019, I was seconded to Marie Stopes Sierra Leone and saw a 19-year-old who had visited a local traditional healer to help her end an unintended pregnancy. The young woman had been brought to the MSI clinic by her mother after several painful days, and on examination was found to have a twig in her cervix. The staff provided post-abortion care – an often life-saving procedure following an unsafe abortion – and it really brought home the importance of safe, legal abortion care in the UK, too, and what is at stake when access is restricted.

To ensure that access to legal abortion care is delivered safely, we must keep facility-based services open, maintaining a choice of medical and surgical abortion methods, and importantly, ensure that women can access these services free from harassment outside clinics, simply for exercising their right to reproductive autonomy.

Calling on government to ensure safe access to abortion care

Fortunately, there are practical approaches that government can take to make safe access possible:

- Firstly, the UK government can decriminalise safe abortion care. Criminalisation creates unnecessary barriers to access, such as the need for two doctors’ signatures, and there is no reason why consensual abortion should have any criminal sanction. By decriminalising abortion care, we can ensure that women can access timely abortion care services, safely.

- Secondly, we know from abortion data from MSI and partners that telemedicine has expanded access, including to the most vulnerable, in a safe, effective, affordable and client-centred way. We call on the government to ensure that medical abortion provision via telemedicine remains accessible both during the pandemic and beyond.

- Finally, we call on government to ensure that anyone who needs to, or would prefer to, access a service via a facility can do so safely, free from harassment from anti-choice protestors, by committing to instating safe access zones at every clinic, protecting both staff and clients.

Women and pregnant people should be empowered and trusted to make their own decisions about their bodies. This International Safe Abortion Day, we call on the government to ensure that they can do so, safely.