by Rebecca Gomperts, Marlies Schellekens, Peter Leusink, GunillaKleiverda
Medisch Contact, 6 November 2019
Women on Web is a telemedicalabortion service based in the Netherlands. Recent research by them shows that some women living in the Netherlandscannot access abortion services in clinics. During a 9-month period, 172 womenliving in the Netherlands responded to an online consultation who were seekinghelp to have an abortion. The responses came not only from the large cities butalso from small villages. They were in Dutch (16%), English (37%),Polish (35%) and other languages (12%). The data showed that 10 women (17%)lived more than an hour travelling distance from a hospital or abortion clinic;38 women (22%) were undocumented, uninsured or had foreign health insurance andcould not afford to pay for an abortion.Contraception had failed for 64women (37%) and7 were pregnant as a result of rape (4%).
The main obstacles to accessing abortion care mentioned by women werehaving to keep the abortion a secret from her partner or family (33%), too highcosts (22%), stigma (11%), protests at abortion clinics (11%), not being ableto arrange care for children (10%), distance to clinic (9%) and domesticviolence (5%). In addition, more than 40% of the women emphasised theimportance of privacy in desiring to have the abortion with pills at home.
Here are the comments of several of the women:
– I havecontacted some clinics for help about this but they all asked for a huge amountof money (one asked for €700, for example). I don’t have the money to raise achild so to pay €700 is also not a solution.
– I have to do this withoutanyone knowing.
– I am a non-workingstudent and this is very very hard for me to fund myself and would requiremonths of saving.
– I am really not ready tohave a child. I’m only 19 and still a child myself.
– I cannot be away from homethat long.
– I have had to keep this asecret from my entire family because this is not accepted at all. Not onlywould there be a backlash, but I would also be forced to keep a child I am notready for, as a consequence of a broken condom.
Research in the USA and England has found similar issues among women –distance to the clinic, psychiatric illnesses, domestic violence – see thereferences below.
If abortion pills were made available from generalpractitioners, many of the obstacles to access abortion services found in theresearch could be solved. The cost of the medication is low. Supervision of anabortion with pills does not differ medically from a spontaneous miscarriage.The World Health Organization recommends low-threshold access. In Ireland,France and Canada abortion pills are already available on prescription from fgeneral practitioners.
1. Aiken ARA, GuthrieKA, Schellekens M, Trussell J, Gomperts R. Barriers to accessing abortionservices and perspectives on using mifepristone and misoprostol at home inGreat Britain. Contraception 2018 Feb; 97(2):177-183.
2. Demand for Self-Managed MedicationAbortion Through an Online Telemedicine Service in the United States
3. Endler M, Telemedicine formedical abortion: a systematic review. BJOG 2019;Aug;126(9):1094-1102.
5. WHO. MedicalManagement of Abortion, 2018. https://www.who.int/reproductivehealth/publications/medical-management-abortion/en