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Abortion is essential: How we're delivering choice under COVID-19

Tuesday 12 May 2020 Katy Footman Safe abortion and post abortion care

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COVID-19 is affecting healthcare the world over, and at MSI Reproductive Choices, we have seen its impact on contraception and safe abortion access globally. With national lockdowns constraining movement and delays in governments acknowledging safe abortion as essential, our clinics have faced temporary closures in several countries. However, our teams are adapting and persisting to ensure we can deliver services when needed most.

What’s at risk? Access to essential healthcare

When women and pregnant people are denied safe abortion services, evidence shows that abortions occur at the same rate, but are forced to take place in dangerous conditions. Abortion is a time-sensitive service, and legal time limits prevent access to safe abortion care beyond a certain gestational age. Delays caused by social distancing, service shutdowns and travel restrictions can make the difference between a safe, legal abortion, and a forced pregnancy or unsafe abortion. 

Due to COVID-related disruptions to our service delivery, MSI Reproductive Choices estimates that between 4 and 9.5 million people are at risk of losing access to our sexual and reproductive health services. This could lead to an additional 1.3 – 3 million unintended pregnancies, 1.2 – 2.7 million unsafe abortions, and 5 – 11 thousand maternal deaths, unless services are protected.

We are already seeing the effects of this in countries like Nepal, where a national lockdown meant that providers and clients were unable to reach MSI Nepal’s clinics, forcing them to close. However, the need for safe abortion care has only grown; we have received an increase in phone calls from women seeking abortion services in Nepal since the lockdown began. Fortunately, by working in partnership with local government, and with support from partners at the WHO and UNFPA, MSI Nepal has been able to re-open 11 clinics so far, with more in the pipeline, enabling people to regain access to medical and surgical abortion care.

Remote care under COVID: Innovations in safe self-administration

With many governments asking citizens to stay home and social distance, it’s essential that we develop models that enable women and pregnant people to access medical abortion care remotely.

We know that self-administration of medication abortion is safe and effective. A recent review from the WHO found that 94-96% of abortions carried out via telemedicine were complete, matching completion rates expected from clinic-based care. Over 90% of clients said they would recommend the service. Evidence like this has been essential for advocates at Marie Stopes UK who, in collaboration with partners at BPAS and RCOG, have successfully campaigned for home-based abortion care through telemedicine in the UK.

Pharmacies and drug sellers also offer an opportunity to put medical abortion drugs in the hands of women during lockdown. Often the first port-of-call for health care, pharmacies have remained open through COVID-19 as they are essential businesses. Pharmacies are often considered a more affordable and confidential option for abortion care, and a growing body of evidence suggests that pharmacy workers can deliver medical abortion products safely and effectively, with similar outcomes to clinic-based medical abortion care. Hotlines and telemedicine models can also ensure that people who self-manage medication abortions from pharmacies have access to high quality information and support throughout the experience.

The evidence is clear that an in-person meeting is not needed for the provision of safe and effective abortion services and that telemedicine and pharmacy provision can offer safe and private routes to have an abortion, without having to visit a clinic.

Maintaining access to clinic-based care through COVID

Although remote models of care can help to safeguard access, it’s important that we don’t forget those who still require access to in-person care. For example, people seeking abortion care in settings that are not yet offering telehealth services; who have contraindications for medication abortion; who don’t have internet or phone access; who need to hide an abortion from people they live with; are at later stages of pregnancy; or those facing complications from a previous abortion attempt. For these people, it’s essential that we keep facility-based services open, continuing to offer safe abortion and post-abortion care.

By working in partnership with local governments, MSI's programmes are now re-opening centres with updated clinical guidelines to keep delivering sexual and reproductive healthcare services under COVID-19 safely. From hand- and respiratory-hygiene, to social distancing with clients and the use of personal protective equipment, these protocols, followed in line with national government guidance, will allow services to remain open and keep our providers and clients safe.

Our team in India, for example, have successfully made the case to national government to define safe abortion as essential, and by following careful clinical guidelines, have re-opened clinics across Rajasthan to deliver crucial abortion services when needed most. 

As remote models of care ensure that access to abortion is not eroded through COVID-19, it is important to remember that quality abortion services respect the client’s right to choose, and that in the longer-term, clinics must be safeguarded to ensure a choice of medical and surgical methods. Evidence has found that clients tend to have a strong preference for one method over another, and satisfaction with services tends to be highest when women can make a choice about method and receive their preferred method. While remote models of care are enabling access to abortion through the pandemic, as social distancing measures are lifted, we need to ensure clinics are protected so that we can serve the needs of all women and pregnant people by safeguarding choice of methods. 

We call on governments to define safe abortion services as essential

Unless action is taken now to protect safe abortion services, the outcome could be devastating. Fortunately, there are evidence-based strategies that governments and the global community can take to protect access to sexual and reproductive healthcare under COVID-19:
  • Governments must define safe abortion and contraceptive services as essential healthcare, and sustain funding for sexual and reproductive services
  • Abortion providers must be supported to adapt service delivery models, enabling safe access to quality medical abortion pills through telemedicine, pharmacies and hotlines
  • Governments and abortion providers must work in partnership to ensure safe abortion services can remain open and deliver in-person abortion and post-abortion care, safely.
  • Governments must remove bureaucratic restrictions on abortion that make accessing care impossible under COVID-19, such as requirements for multiple doctors’ signatures.

We will always need access to abortion care. Whether we can access abortion safely and with dignity under COVID-19 is in the hands of governments to decide.

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