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2021 in review: a year of ups and downs in global abortion rights

Friday 17 December 2021 MSI Reproductive Choices Contraception, Safe abortion and post abortion care, Policy and advocacy, Women's health

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With the US Supreme Court on the verge of what could be the most significant rollback of abortion rights in a generation, we look back at a year in which abortion rights globally have been lost and won.

As we approach the end of the year, Roe v Wade, the landmark 1973 Supreme Court judgement, which legalised abortion across the US, is facing its biggest challenge in nearly 50 years. Reproductive rights supporters fear that if the US Supreme Court rules against a woman’s constitutional right to an abortion, the impact could reverberate around the world, further emboldening an active anti-choice and anti-gender movement that has already seen countries, including Poland, El Salvador, and Hungary, roll back abortion rights as part of wider attacks on a free civil society and human rights this year.  

Reasons to be hopeful 

However, despite these setbacks, we believe there is cause for hope globally. This year alone, abortion has been legalised in Benin, Thailand, San Marino, Gibraltar, and decriminalised in Mexico; with Colombia and Chile also considering following suit. 

In response to anti-choice threats, pro-choice campaigners have joined in solidarity. As several Latin American countries such as Mexico, Colombia, Argentina, and Chile seek to turn the tide on regressive abortion policies, the same green scarves worn by pro-choice advocates across Latin America are appearing in protest movements globally as a powerful symbol of unity.  

The continuing success of telemedicine 

As well as positive legislative change, in 2021, we’ve seen continued innovations in abortion care delivery. An MSI UK study released in February 2021 quantified the positive impact that access to at-home abortions has provided since April 2020. 

The study found that 8 out of 10 (83%) clients reported preferring telemedicine during COVID-19, and two-thirds say they would still prefer telemedicine even if there was no pandemic. It also found that telemedicine provides robust safeguarding for at-risk clients and onwards referral pathways for those that need it. At 95.3%, nearly all of our clients were able to speak with their trained health advisor in private. A further 4.6% were able to speak in private when they sought out a private space. 

Since the start of the pandemic, MSI UK has provided nearly 35,000 people with access to telemedicine. And, with a decision by the UK Government on whether to make telemedicine permanently available expected before the end of the year, two-thirds of clients (66%) would choose telemedicine again if Covid-19 were no longer an issue. With the UK set to face a sharp rise in COVID cases over the coming months, and with the NHS stretched to capacity, it is vital that people are still able to access this service.  

Similarly, in South Africa, we have been able to reach over 10,000 clients, reaching the most marginalised with telemedicine services even with the country’s own health services also stretched. 

MSI has also worked closely with the Government of Nepal to introduce interim guidelines that have helped MSI staff to provide medical abortion services in women’s households. With clinics closed due to a deadly COVID-19 wave in the spring, this ensured that women were able to access vital services. Similarly, in Ethiopia, nurses and midwives are now permitted to provide second-trimester abortion services closer to women at the community level. 


Advocating for improved services 

2021 was a successful year for our global advocacy teams. Globally, our advocacy work has helped roll out Safe Access Zones to prevent clients being harassed outside our clinics. Along with buffer zones being instated across several states in Australia, MSI UK's West London clinic had its buffer zone renewed and we continue to use evidence to advocate for a national Safe Access Zone policy across the UK. 

In Ghana last month, the National Health Insurance Authority (NHIA) approved the inclusion of family planning services and commodities in the benefits package. The approval means that from 1 January 2022 permanent methods, IUDs, implants and injectables will be free for members of the National Health Insurance Scheme. This has the potential to transform contraceptive access for women in Ghana by removing cost barriers and increasing the number of providers trained to fit and remove long-acting reversible contraception (LARCs). 

The approval follows several years of advocacy work and a two-year FCDO-funded pilot study that demonstrated the impact of removing out-of-pocket barriers to family planning. 

Elsewhere, in Zambia, we have broken down national sexual health and reproductive health data by age that will help MSI Zambia to better overcome the barriers adolescents face accessing services and programme youth-friendly services that ensure that no young person is left behind.  Critically, age disaggregation will better capture those under 15, ensuring that they have access to better sex education. 

Determined in the face of global opposition 

Despite the efforts of a vocal minority that wants to limit women’s reproductive rights, every day we see growing public support for our services. We see advocates removing unnecessary barriers and a new generation of activists inspired to protect reproductive choice. These acts of hope and solidarity inspire our teams to do all they can to make choice possible for women around the world.  


Invest in women's futures

Our estimates show that it costs less than 2 pence/3 cents per day to provide a young woman with a contraceptive method of her choice. It is a cost-effective investment that produces a lasting and sustainable impact. By enabling girls to stay in school, supporting women to forge their careers, and better equipping communities to be resilient in the face of global challenges, from COVID-19 to the climate crisis, reproductive choice is foundational to building a more equal and sustainable world for all.


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