CAMPAIGN REPORT – Changes in access to abortion services during Covid-19: Report for UK SRHR Network & DFID Online Meeting, 15 May 2020

by Marge Berer

The Campaign’s membership consisted of 1,446 organizations and individuals in 129 countries as of February 2020. They include a wide range of international NGOs, institutions, agencies and organisations; international and regional networks; national coalitions, human rights and women’s groups and organizations; and a wide range of individuals such as policymakers, health professionals, human rights activists, journalists, academics and students.

The Campaign newsletter aims to share news of international and regional significance affecting abortion, reports from our members of their work, and a wide range of articles, publications, videos and other resources on abortion. It is published twice weekly.

We began devoting all newsletters to the Covid-19 pandemic starting on 25 March 2020, including its consequences for abortion policy, access to abortion services and methods, including abortion pills, and where abortions are taking place, as well as related issues to do with sexual and reproductive health and rights, other health issues, global public health and determinants of health, and policies for dealing with the virus.

This report is based on more detailed country reports in those 16 newsletters up to 15 May, and provides an overview and wider perspective on what is happening. The report is divided into two main sections: what is happening in countries where most abortions are legal and in those where most abortions are illegal. The countries we have reports from are listed under each heading. In line with endless national permutations in law and policy and in access issues, each country has somewhat different situations, all more complex than can be summarised in a few words. Some countries reflect several of these categories all at once, depending where you look in the country and in the health system.

I. In countries where abortion is mostly legal, changes fall into four main categories:

1. Governments have confirmed abortion is essential health care, women are able to get abortions as normally, nothing is said to have changed due to the virus.

– Russia (outside Moscow), Netherlands, Denmark, Sweden

2. Provision of abortion has been stopped in whole or in part either by ministerial decree or by specific hospitals on the grounds that abortion (like other services that have been stopped) is routine, inessential, non-emergency, or not a priority, or the hospital/clinic has been taken over for Covid-19 patients.

– Slovakia, Lithuania, Poland, Romania, Moscow (only 3 of 44 clinics open – contested information), Austria (only 5 clinics open)

3. Women have always had to confront barriers to getting a legal abortion; there are now additional barriers, e.g. absence of providers due to illness and self-isolation, women not permitted to travel or cross a border, no public transport, provision of second trimester abortions stopped, and supply chains and services disrupted for obtaining abortion pills.

– Italy, Spain, India, Japan, Mexico outside Mexico City

4. In some countries, progressive changes have been put in place to facilitate access to abortion, e.g. reducing the number of clinic visits, allowing use of telemedicine for first trimester abortions, allowing self-managed first trimester abortion with pills at home, doing referrals online for women seeking an abortion provider, and moving surgical/aspiration abortions from inpatient clinics often at tertiary level to outpatient clinics.

– Ireland, Great Britain, France, Moldova, 13 US states, Canada, Kenya (one network of doctors doing online referrals), Nepal, two major abortion providers in Colombia, Mexico City clinics (but providing abortion pills only), Slovenia, Germany, Tunisia

II. Where abortions are mostly illegal, there are also four main categories

1. As regards post-abortion care services in public health systems – We have in fact not received any information. These are almost entirely public hospital-based services and are mainly or only for treating complications of unsafe abortions alongside other emergency obstetric care. That should classify this treatment as an emergency service, which means it should still be operational, but this is not necessarily the case. Preparing this report brought this absence of information to the fore. It is important for us to find out what is actually happening.

2. There are safe abortion information hotlines, of which two cater for women internationally, and the rest are in 37 countries, the great majority in Latin America, Africa and Asia. They are part of an international network of hotlines and have been initiated and are run by women’s health and rights groups. They have had training or trained themselves to provide free, safe, reliable information about unwanted pregnancy, abortion and post-abortion care. Many also provide information about contraception and emergency contraception. Hotline volunteers have been trained and provide accurate information from reliable sources, especially the World Health Organization, in confidence. They are aware of national laws and policies, and the situation for services. They can advise women on how to use medical abortion pills safely, and how to seek help if it is needed. They are not part of the formal health system, though they may work with and refer women to specific clinics, e.g. for incomplete abortions.

3. More women are getting pills from online pharmacies and local drug sellers, but not necessarily from bona fide sources nor necessarily getting instructions on safe and effective use. There would need to be studies at country level to ascertain this.

– USA (there are a range of known bona fide sources)

4. Health Ministries in several countries have published comprehensive guidance on addressing Covid-19 within sexual and reproductive health services, but in three countries where most abortions are illegal or outside the health system, these guidance documents have focused mostly on maintaining pregnancy and maternity care and preventing an increase in maternal deaths. India’s and Kenya’s guidance fail to mention abortion at all, Mexico’s mentions it only briefly, and includes miscarriage in its brief treatment of abortion.

– India, Kenya, Mexico

A second report for the coming UK SRHR Network and DFID meeting on 11 June 2020 has also just been prepared to bring this first report up to date. Information for that comes from a cross-country report from Latin America & the Caribbean, and country reports from the Philippines, Thailand, India, Romania, Australia, and France. The 1 June WHO updated guidance on Covid-19, which includes guidance on safe abortion care as essential health care, is also included. The six regular Campaign newsletters between 15 May and 9 June 2020 carry these individual reports.