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The Government needs to help women access abortion - despite coronavirus

'Having an abortion is an unpleasant enough experience when you're not attempting to do so during a global pandemic'
'Having an abortion is an unpleasant enough experience when you're not attempting to do so during a global pandemic' (posed by model)

Having an abortion is an unpleasant enough experience when you're not attempting to do so during a global pandemic. There’s the prospect of protestors outside the clinic, the depressing waiting room and then there’s the physical toll that it takes on your body. The only silver lining of the entire experience is that if you live in the UK it will be readily available to you. Or at least it was until recently. 

Yesterday within a matter of hours the government announced - then un-announced - that women would be able to take abortion medication in the privacy of their own homes (known as telemedical abortion), a move which seemed briefly set to solve the abortion crisis currently brewing in the UK. 

In an attempt to prevent the further spread of Covid-19, the Prime Minister has told us all to stay at home, unless we’re going to buy food, take brief exercise or attend an essential medical appointment. Beyond that, he has asked 1.5 million vulnerable people in the UK not to even do those things, but instead to self-isolate, full time. No food shopping, no exercise and no medical appointments. 

All very sensible. But if, like 24 per cent of pregnant women, you need an abortion, you’ve got a serious problem. And even if you can leave the house, you might still struggle to access reproductive healthcare. 

Twenty-three per cent of the British Pregnancy Advisory Service’s (Bpas) clinics were closed earlier this week due to staff sickness. Under usual circumstances it can take around two weeks to get an appointment for a medical abortion, but with the current pandemic ravaging all medical services, the wait is often a lot longer, dependent on where you live.

Anyone who has had a medical abortion will know that time is of the essence. Staying pregnant when you don’t want to be pregnant is torturous, and the earlier the abortion takes place the less physically arduous it is.  

"I had to wait three weeks to get an appointment," an anonymous 29-year-old who had an abortion last year tells me. "It was, without a doubt, the worst three weeks of my life. Every pregnancy symptom reminded me of what was happening to my body. It took a toll on every aspect of my life. I shopped online for at home abortion drugs, and only resisted buying them when I read that they could kill you. But I was so desperate that I seriously considered taking the risk. I can't imagine how desperate other women must be right now, and I'm scared of what women might do. It feels Victorian."

While the prospect of missing the nine week and 6 day window for a medical abortion is awful, it’s not the full extent of the risk. "Being forced to continue a pregnancy that you feel you cannot continue is awful at the best of times and during this pandemic will be even worse," says Katherine O’Brian. 

"If women aren’t able to access early medical abortion they may have to have surgical abortions, which may be impossible as hospitals are reserving resources to deal with Covid-19. Being delayed in accessing treatment is a problem in and of itself, and we are also concerned that if they are delayed into the second trimester they won’t be able to access abortion at all."

Bpas shared a message that they had received from one extremely distressed woman, which reads: "This way [telemedical] of abortion is the only route I have as I am not allowed out due to the coronavirus… My parents would disown me and kick me out if they were to find out or they may even harm me and I have so much ahead of me. I cannot afford to have a child right now at such a young age with no financial help, as the person whom I conceived the child with is no longer in my life. I beg you to please help me, this is my only option. Please help me."

In theory both the problem of accessibility, and the problem of clinic closures would fixable – if telemedical abortions were permitted.

A telemedical abortion would mean that a woman could take the medication - usually an oral pill and a pessary - at home. But, just hours after it was announced yesterday that telemedical abortions would be permitted during this period, the announcement was quickly retracted with a spokesperson for the Department of Health and Social Care saying that it had been "published in error", and that there will be "no changes to how abortion services are regulated." 

As far as Bpas are concerned, there is no scientific reason for this, a sentiment shared by NICE (the National Institute for Healthcare and Excellence), which also supports telemedical abortion. 

Dr Jonathan Lord, co-chair of the Royal College of Obstetricians and Gynecologists (RCOG), said: "I simply cannot understand why the Government is behaving in such a cruel and reckless manner towards women’s health.  To force women to have to come out of self-isolation, mix with others in waiting rooms - and in many NHS waiting areas, distancing is impossible - and potentially infect others and NHS staff is quite extraordinarily irresponsible. 

"Accessing care remotely by telemedicine is already recommended as best practice by the UK NICE guidelines, and joint guidelines from the RCOG, the Faculty of Sexual and Reproductive Healthcare and the British Society of Abortion Care Providers confirm that this is safe, effective, recommended by many healthcare systems. It is the only reasonable way to run services during the pandemic without endangering both women and NHS staff."

Another simple way to make abortion more accessible during the pandemic would be to change the outdated rules around how an abortion is signed off.

Franki Appleton from Marie Stopes explains: "Unless a doctor is in a registered clinic, they cannot sign off legal grounds for an abortion or prescribe the medication. Yesterday’s short-lived changes to legislation would have enabled doctors to do that very vital role from home - for instance while self isolating. It’s completely medically unnecessary to have a restriction on where a doctor can physically sit in order to provide expertise."

If ever there was a time when women needed access to safe, reliable medical abortion, it’s now. Some of the major reasons that women have abortions are being unhappy in a relationship, being unsafe in a relationship, or being unable to afford to have a child. Law firms are reporting an uptake in enquiries about divorce. Domestic violence charities have predicted that self-isolation will lead to a spike in abuse. While the Chancellor has said that the Government will take care of us, statistics show that around 700,000 people in the UK are likely to lose their jobs.

It can hardly come as a surprise, then, that women all over the UK need a way to discontinue their pregnancies.

I asked Appleton what women should do if they do find themselves in the position of requiring an abortion, given that the legislation which would have made this situation so much easier was over before it began.

She told me: "Women who currently require an abortion should still call us. We can provide advice over the phone. The vast majority of our centers and clinics are still open, and we’re pulling out all the stops to make sure we can still provide services. We can do consultations, safeguarding and medical checks over the phone, but as it stands they would still need to visit a clinic to collect the medication. Abortion is an essential medical service and therefore  it is a valid and legitimate reason to leave the house."