Early this week, a spokesperson for the UK Department of Health and Social Care confirmed that the Government was updating its guidance for women seeking abortions. Women would now be allowed to take both abortion pills at home for pregnancies up to 10 weeks. This followed days of pressure from abortion providers and others who have in fact campaigned for years for the Government to allow ‘home abortions’. The Government U-turn is telling, and raises serious questions about healthcare and women’s safety and well-being.
What should we make of this move? In the very recent past, the Government has resisted home abortions on the grounds of women’s safety. Only last week, a government minister assured us that “We believe that it is an essential safeguard that a woman attends a clinic, to ensure that she has an opportunity to be seen alone and to ensure that there are no issues.”
Worries about medical safety and coercive control were at the fore. Have these now become irrelevant? In the context of legitimate fears about a likely increase in domestic abuse during the Coronavirus lockdown, does it really make sense to remove a safeguard against coerced abortions, for example?
We know that intimate partner violence (IPV) is a strong risk factor for abortion all over the world, with a WHO multi-country study of women’s health and domestic violence finding that women with a history of IPV have increased odds of unintended pregnancy and almost three times the risk of abortion. In a study of London clinics there was a six times higher rate of IPV in women undergoing abortion compared with women receiving antenatal care.
Often enough, such violence is exerted against the pregnant woman precisely in order to force or coerce her to abort. And IPV is only the most extreme form of coercion that women can experience when pregnant. Much subtler forms of coercion and pressure are frequently reported by those women who were subsequently devastated by the psychological after-effects of their abortions.
For many years, abortion providers have been insisting on the importance of seeing women ‘alone’ when advising on abortion. How likely is that privacy now, when it comes to telephone conversations in a state of lockdown? With pregnancy rates predicted to increase in a lockdown situation, what is to stop the coercive boyfriend (or parent) demanding the woman or girl take the abortion pills, thus solving a problem as they see it?
Hospitals in England have been told to postpone all non-urgent elective surgery from 15 April (this is similar to a directive of the US surgeon general, which has the support of the major obstetrics and gynaecological organisations). When it comes to abortion pills, we are not talking about surgery, but it is still the case that almost every abortion is non-urgent and elective: these are not life-saving interventions.
However, if an abortion goes wrong, especially an abortion at home via pills, the woman may indeed need urgent treatment. She may, for example, need a blood transfusion after excessive, prolonged bleeding. If she needs an ambulance and urgent medical attention, will she get it, during the current crisis? Who will know if her pregnancy is ectopic? Many women will be aborting alone, and even where it is not life-threatening, medical abortion is often painful and can be emotionally very distressing.
The policy makes little sense in terms of risk. Even small risks of adverse consequences become serious where physical side-effects cannot be quickly addressed by an over-stretched health service. Just as one would not take even a relatively small risk in crossing a rickety bridge over a dangerous ravine when one could cross the ravine easily a little further down the path, so offering women home abortions in these circumstances is hard to defend on any criterion. After all, clinics are still open, and women will often still be able to access them, assuming they do not choose instead to have their babies.
It is disturbing that one particular non-urgent elective intervention is being prioritised above all others, and at the cost of safety by being performed away from a hospital or clinic. How is good and equitable medicine being served by this decision?
As someone once said, never let a crisis go to waste. Sadly, during this crisis, certain groups have pressured the Government to take the step those groups always wanted – removing medical abortion from the effective oversight of medical staff and putting it in the hands of women in situations where they will have none of the minimal protections they used to have.
A woman with a crisis pregnancy is vulnerable. She needs to be offered protection and support, not powerful medications that place her at risk, physically, emotionally and psychologically, and without medical care in a lockdown situation. At a time when we rightly praise our healthcare professionals, we need to think carefully about what has happened to medicine in the context of abortion.