BELGIUM – Abortion pills at home made possible by the pandemic

The first lockdown had brought Belgium to a standstill. The centres that provide abortion services looked for solutions to keep it accessible. Patients were restricted in their movements, and some centres wanted to avoid having too many people in their premises at one time.

They began to offer women the option of abortion pills at home, which was already common in France and the Netherlands and “was already under discussion before the pandemic”, according to Cécile Olin, director of the Louise Michel Centre in Liège. “It was an opportunity to make it happen.” This was not taken for granted, some doctors were reluctant. “For a medical abortion, the patient normally stays with us for half a day, so we said to ourselves that this was not ideal,” Cécile Olin continued.

It was the second step of a medical abortion – the misoprostol – that normally took place in the centre, with support from a doctor and a woman companion. “Support is important,” defends Dr Nathalie Carlier, medical coordinator of the Louise Michel Centre. “It is often thought that it is enough to take the medicine and then it is over, but there may be pain, cramping, bleeding. Complications are rare, but it’s important to be there to reassure patients.”

So that this second step can take place at home, the centres have therefore set up a support system by telephone. “We decide together with the woman when she will take the misoprostol tablets, and then we call her regularly,” explains Dominique Roynet, a general practitioner at the Rochefort Family Planning. “The patient can also call us.”

The Rochefort Centre was already offering this possibility before the pandemic began. “There was a demand from some of the women, so we had already started to experiment.” There are conditions – the patient must already have had an obstetric or miscarriage experience, she must not live too far from the centre so as to be able to go there in case of need, and she must not be alone but able to be driven if needed.”

According to Dr Isabelle Bomboir, who practises in Watermael-Boitsfort, Ixelles and at the City Planning of Saint-Pierre Hospital in Brussels, abortion at home is not more dangerous, it does not lead to more complications and is no less effective. “We did a comparison at City Planning, between 2019 – when there was no abortion at home yet – and 2020, and there was no change. A study carried out in England and Wales with 29,000 patients reached the same conclusions. However, there everything is done by teleconsultation: unlike with us, even the very first contact is by telephone.”

Now, most centres continue to offer the possibility of abortion at home. “Many women are very positive about it,” believes the director of the centre Louise Michel, “but it is not suitable for all. Some do not have the ideal conditions at home, and it is difficult to do when the children are there, for example.”

However, the proportion of medical abortions continues to increase. In the GACEHPA centres (Action Group of Non-Hospital Centres Practising Abortion), it went from 30% in 2015 to 40% in 2020. (The same upward trend exists in the national figures, but to a lesser extent).

However, Dominique Roynet is not particularly favourable towards this method: “In reality, it is a miscarriage, it is not easy to cope with. Apart from the bleeding and pain, there is also seeing the sac or sometimes the tiny fetus, it has a psychological impact. On the other hand, some women express a feeling of guilt because they have aborted themselves.

For the general practitioner, medical abortion is offered in particular by doctors who do not know how to carry out a surgical abortion: “There is a lack of practising physicians, and therefore we are promoting medical abortion, but in reality it is not, not a real choice. ”

On the other hand, the increase in the number of medical abortions is also explained by the fact that women come to consult earlier and earlier in their pregnancy. It is only allowed until about 9 weeks of amenorrhoea. So if women come earlier, they are more likely to have access to this method.

There are no official global figures yet, but all the centres we contacted have observed this trend. Dominique Roynet has been providing abortions for 40 years, and she assures us that she has never seen such an evolution in practice in such a short time. For her, it has been gradual, it’s been a few years already. For others, it is especially specific to the year 2020.

Are women more informed? More focused on their bodies?
Everyone is looking for explanations: at the Louise Michel Centre, as at Rochefort, we make the link with the media attention paid to the issue of abortion in recent years. The law changed in 2018, and there was also a lot of talk about the bill (which ultimately failed) to amend it again. “Women are probably more informed, more aware of their rights, supposes Cécile Olin.

At the CHU Saint-Pierre, we have a more concrete explanation, but which does not correspond to the reality of the other centres: during a period of lockdown, the centre does nothing else, all other activities are suspended, and so the time women have to wait before having an appointment is shorter.

We will probably have to wait until we have more perspective to see more clearly. Whatever the explanations on this precise point, the pandemic will have had an impact on the practice of abortion .It will have allowed access to abortion at home, it may have enabled women to consult earlier, and, in some cases, it will also have enabled them to abort sooner after the first appointment.

This is the case at the Rochefort Family Planning Centre, where the women were able to abort the same day. “Those who did not need to observe the waiting period any longer had tests in the morning and could have an abortion the same afternoon,” explains Dominique Roynet. We wanted to prevent women from travelling too much since they needed permission to move by car and, with us, patients often come from far away. ”

The law normally imposes a waiting period of 6 days, unless there is an urgent medical reason for the woman to have the abortion more quickly. “We felt that our patients were in a situation of emergency,” defends the general practitioner.“ And now, we continue to offer this possibility, we decided that it was a step forward and that we would not go back because it is a plus for some women.”

Practices have therefore changed, definitively. “This is the genesis of progress in the doldrums,” concludes Dominique Roynet.

SOURCE:, by Daphne Van Ossel, 26 April 2021. Translated from French.