Safe Abortion Is Essential Healthcare
No More Clandestine Abortions!!!
The past 16 months have seen both successes and setbacks in the right to safe abortion in the midst of the Covid-19 pandemic. There has been progressive abortion law reform in Argentina, South Korea, Thailand, Ecuador, and South Australia, and use of telemedicine to provide abortion pills in Ireland, Britain, France, USA, Nepal and elsewhere. But the situation has gone from bad to worse elsewhere.
A pandemic puts the need for access to safe abortion into sharp relief, increases the risks of unsafe abortions, and reinforces the need for safe abortion to be available as essential health care. With the poorest and most marginalised women and girls worst affected, the pandemic has restricted access not only to safe abortion but also all other sexual and reproductive healthcare services, including pregnancy and delivery care. Maternal deaths have risen substantially in some places, alongside violence against women.  Right-wing governments are showing increasing hostility to women’s rights. Progressive sexuality education and anything related to gender are condemned without rhyme or reason.
National and local lockdowns, quarantine, travel bans and closed borders, while necessary for making people safe from Covid-19, have made access to health care of all kinds even more challenging than usual since March 2020. Abortion is time-dependent. Delayed access to safe abortion creates a risk to life and health, as does turning to unsafe abortion in a panic when nothing else is available.
Telemedicine has been endorsed as a means of providing for many critical health care needs by phone or computer, especially during a pandemic.  It is being adopted for a rapidly expanding list of clinical consultations, with delivery of medications through the post or by local pharmacies.  Telemedicine for arranging self-managed abortion is a safe solution for many women, both now and after the pandemic. As hospitals and other healthcare facilities are overwhelmed with caring for large numbers of Covid-19 patients, pharmacies have become an even more vital access point for medicines, healthcare services and advice. Some of these changes have emerged as positive developments during the pandemic. They will remain valuable going forward as a way to reduce unsafe abortion.
For this year’s International Safe Abortion Day, we call upon all countries to:
- remove laws and policies restricting access to safe abortion;
- facilitate access to safe abortion and post-abortion care for everyone who needs them;
- ensure that post-abortion care is universally available on an emergency basis, provided at community level by midwives trained in MVA and/or with pills;
- move most abortions out of secondary and tertiary hospitals into community-based, primary care, day clinics, run by trained nurses, midwives and other mid-level providers;
- allow the use of telemedicine and self-managed abortion up to 12 weeks of pregnancy, in line with WHO guidance ;
- allow outpatient medical abortion in the second trimester, with social distancing in the clinic and without requiring operating theatre conditions;
- approve medical abortion pills (mifepristone and misoprostol) on national Essential Medicines Lists;
- decriminalise abortion to the extent possible − expanding legal grounds, increasing the upper time limit, removing barriers and third party approval.
We urge everyone to develop vigorous advocacy campaigns to demonstrate to governments and health professionals the safety, efficacy and acceptability of de-medicalised approaches to abortion, including MVA and medical abortion pills provided at primary level and by telemedicine.
 Guttmacher Institute April 2020, www.guttmacher.org/sites/default/files/article_files/4607320.pdf
 International Federation of Gynecology & Obstetrics, Abortion access and safety during Covid-19. 31 March 2020.
 Paul Webster. Virtual health care in the era of COVID-19. The Lancet, 11 April 2020;395(10231).
 World Health Organization. Medical Management of Abortion, 2018.