Ensure access to high-quality abortion care during and after the COVID-19 pandemic

by Kelly Blanchard, Thoai D Ngo

A new Cochrane review, from scientists at the Population Council and the WHO, examined data from 18 randomized and non-randomized comparative trials with more than 11,000 women in ten countries, and found that women who self-administered abortion drugs in early pregnancy had similar rates of successful abortion and of safety as women undergoing provider-administered procedures in lower middle income countries (LMICs) and the United States. Most studies used the combination regimen (mifepristone and misoprostol) where women took the second drug (misoprostol) at home. A scoping review by researchers atIbis Reproductive Health investigated evidence from almost 100 studies covering a wider range of abortion methods. The authors also found that self-management with medication abortion drugs was safe and effective.

Self-management of medication abortion has been documented in legally restrictive and legally permissive countries. Online providers like Women on Web and Women Help Women have been supporting people through the process remotely without in-person interaction with a clinical provider for years. We know that many women prefer to manage their abortion in the comfort in their own home. Telemedicine has also shown to be a safe and effective option; a 2019 review and a clinical study in Iowa documented similar safety, effectiveness, and self‐assessment of outcomes in comparison to routine clinic appointments. 

Researchhas also shown that self-management of medication abortion later in pregnancy (beyond nine weeks) can be safe and effective.

Abortion is an essential health service, and access to surgical abortion services remains critical, especially for those seeking later abortion care, and others who prefer it. Supporting people’s ability to manage their abortion care will protect reproductive and human rights – and reduce demands on our health systems. As the global scientific evidence continues to grow, we hope self-managed abortion will become an option for everyone who wants to end an unwanted pregnancy.

Decision makers should use this evidence to drive immediate changes in law, regulations, and services during and after the pandemic. Governments and health systems should make information about and access to self-managed medication abortion available as an urgent strategy to address the Covid-19 pandemic. As this global health crisis continues to reshape our lives and health systems, let’s use this moment as an opportunity to provide more options to women, and ensure their rights, health, and well-being are priorities even as we take the necessary steps to address the pandemic.

SOURCE:Thomsen Reuters Foundation,2 April 2020