INDIA
In India, it is not possible to get medicalabortion pills without prescription in a few states, such asMaharashtra.This forces women to go to a clinic to get safe abortionservices (if doctors are willing to give them during this crisis) or they willhave to getthe pills from other sources or cross state lines for them.
FOGSI (Federation of Obstetric & GynaecologicalSocieties of India) published a short-term advisory in response to the pandemicbut it said nothing about abortion services though it recommended stopping manyroutine and non-urgent maternity and SRH services.
In many places, the Indian Medical Association and/ordistrict administrations have sent advisories to suspend all clinical work.They are concerned India may see shortages of medications, contraceptives, HIVantiretrovirals and antibiotics to treat STIs due to disruptions in supplychains from companies in China or India.
For every early abortions with pills, doctors can providepills to the patients. But with the current lockdown in most cities in India, e.g.in Mumbai, Pune and Delhi, there is no public transport and doctors are unableto reach their clinics. The Family Planning Association of India have struggledto keep their clinics open. Without public transport, young women cannot reachclinics. There is a lot of fear around visiting public places, especiallyhospitals, where numbers of people with the virus are increasing.
Our advisor at Hidden Pockets recommended that “Below 6weeks or even up to 9 weeks doctors can do medical management and provide helpwith tablets. We are only dealing with medical emergencies like ectopicpregnancies.” Other advice includes: specialized abortion care centres at lowat risk of COVID-19 should ideally continue to provide services, no routineantenatal visits, minimise evacuations if they can be managed medically orexpectantly, suspend all infertility management, suspend cervical screening butmanage abnormal smears,
HiddenPockets says: “Don’t panic… WhatsAppus at 8861713567with any query.”
E-mail: Shilpa Shroff, 23 March 2020 ; HiddenPockets, 23 March 2020 ; HiddenPockets, 24 March 2020
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USA
PlannedParenthood abortion clinics are staying open during the coronavirus outbreak
OnePlanned Parenthood affiliate said it’s actually seeing an increase in patientsshowing up for appointments as people grow concerned about their healthinsurance and access in the future.
PlannedParenthood USA wants people to know that its doors are still open, even as thecoronavirus epidemic sweeps the nation. “Our doors will stay open becausesexual and reproductive health care is extremely important, and we have toensure access to it,” Meera Shah, chief medical officer for Planned Parenthoodin the New York City suburbs of Long Island, Westchester, and Rockland, one ofthe hardest-hit regions in the country, told BuzzFeed News Thursday over thephone. “Pregnancy-related care, especially abortion care, is essential andlife-affirming, especially now when there is so much insecurity around jobs andfood and paychecks and childcare.”
BuzzFeed, by Ema O’Connor, 20 March 2020
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Abortion access isunder threat as coronavirus spreads
In many states, abortion clinics are holding on by a thread.Last week, Joe Nelson, a physician who provides abortions in Texas, felt atickle in his throat. Then he started coughing. His temperature soared. Unableto obtain a coronavirus test, he began self-quarantining for 14 days. In a phonecall with HuffPost, Nelson said he was mostly worried about how his unplannedabsence might affect women’s ability to get abortions in the state.
HuffPostUS, by Melissa Jeltsen, 17 March 2020
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TelAbortion: a model for telemedicine duringthis public health crisis
Telemedicine for abortion has the advantage that staffcan work remotely, and during the epidemic can work from home with flexibleschedules. This safeguards the health and welfare of staff, patients, partnersand community, and ensures access to an essential health service withouta clinic visit during this public health crisis. Gynuityis adapting the TelAbortion model to be able to expand quickly to serve morepeople needing abortion now that doctors are given permission to provide careoutside their states of licensing and the Food & Drug Administration’srealization that not all recommended tests will be possible (or necessary) forall patients. Gynuity is committed to conducting ground-breakingresearch helping to develop new clinical care models.
Gynuity Health Projects. E-mail, 20 March 2020
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Ohio abortionproviders told to stop all ‘non-essential and elective’ surgical abortions
Ohio’s attorney general cited federal guidance for thisruling intended to help conserve “needed medical supplies” during the pandemic.There are concerns that the demand for hospital beds could exceed supply in theUS — and medical providers are currently experiencing a severe shortage of thepersonal protective equipment that allows them to safely interact with infectedpatients. Trump administration officials have asked “every American and everyAmerican hospital and healthcare facility to postpone any elective medicalprocedures”. However, abortion is not “elective”: you can’t put it off for sometime in the future. Planned Parenthood responded by saying they are complying,but added: “Under that order, Planned Parenthood can still continueproviding essential procedures, including surgical abortion, and our healthcenters continue to offer other health care services that our patients dependon.”
Vox,by Riley Beggin, 22 March 2020 ; NationalPublic Radio, by Sarah McCammon, 21 March 2020
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UK
On 23 March 2020, an e-mail notice came from the RoyalCollege of Obstetricians and Gynaecologists that the Government had announcedtwo temporary changes to abortion care that would allow clinics to offer a remoteservice, limiting the potential spread of COVID-19 and helping to maintain accessto abortion care:
- The home of aregistered medical practitioner is approved as a class of place for treatmentfor the termination of pregnancy for the purposes only of prescribing themedicines known as mifepristone and misoprostol…
- The home of a pregnantwoman who is undergoing treatment for the purposes of termination of herpregnancy is approved as a class of place where the treatment for termination ofpregnancy may be carried out…
However,the bad news is this policy change was withdrawn by the Secretary of State forHealth six hours later without explanation. Parliament has been shut down yetagain so we don’t know how to fight this.
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NORTHERN IRELAND
Early medicalabortion coming to three health service trusts as advocates argue fortelemedicine
During Northern Ireland questions in the UK House of Commons, Labour MP Diana Johnson asked for an assessment of the effect of the collapse of the airline Flybe on the ability of women in Northern Ireland to access abortion services in England, due to the European Union 30-day ban on all ‘non-essential’ travel. Activists are fighting for the legalisation of telemedicine for abortion or to deem travel for abortions “essential travel”. Alliance for Choice NI believes telemedicine will provide a safe way to support abortion seekers throughout the coronavirus crisis.
FROM: Belfast Telegraph, by Jonathan Bell, 18 March 2020 ; Marie Claire, by Niamh McCollum, 18 March 2020
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FRANCE/(SPAIN+ NETHERLANDS)
A situation reportwith things changing daily
Most of the Mouvement Français pour le Planning Familial centres have had to close becausewe could not ensure the protection of the staff (no masks, no hydroalcoholicgel, no public transport). Some remain open, and we have increased the numberof staff answering phone calls. There are manymore calls now… 725 last week compared to 250 in the same week last year.Our doctors and midwives provide medical abortion. Medical abortion at home ispossible, and women can be followed by telemedicine, but women must see a doctorto get the pills. It would be great if they could do the whole process via telemedicineand get the pills from a pharmacy, but it’s not possible right now. An emergencylaw was passed last weekend, but they did not agree to extend the abortion timelimit. Telemedicine for abortion has not yet been discussed, but it has beenproposed. For later abortions, we were told that women could be authorized totravel to Spain or the Netherlands with a special paper; it works for most ofthem but not all. Some have been stopped at the border.
In Spain, some clinics are open for the moment. In the Netherlands,too, but women must present alone, their temperature is taken when they arrive,and they must not have symptoms of the virus.
We advocated for the existing law on urgent care to beapplied to abortions. The government accepted this and published the notice,and we will be more than vigilant about it. We will go on advocating for ahigher upper time limit, abortion for medical reasons without restrictions, accessto later abortions for fetal disease or malformation or risk to the woman, andfor abortion through telemedicine.
The joint platform Avortement Europe: les femmes décident(Abortion Europe: Women Decide) have launched an onlinepetition for the following:
• Mandatory maintenance of abortion services and supply ofcontraceptives;
• A supply of masks and hydroalcoholic gels for clinics sothat they can continue to function;
• Removal of the requirement of a second appointment forminors, 48 hours after their first appointment;
• That a woman requesting an abortion can find it locally,whatever her place of residence or her healthcare cover, and with or without theright to remain in France.
The recommendationsof the French National College of Gynaecologists and Obstetricians forabortions and contraception during COVID-19. Thankfully, they changed theirminds about cancelling consultations for contraception. Women can renew aprescription for contraception at the pharmacy by showing the previousprescription.
E-mail from Veronique Sehiers, Co-Director, MFPF, 26 March2020
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ITALY
Avoid puttingabortion at risk by facilitating access to abortion pills outside hospitals
The evolutionof the COVID-19 epidemic in Italy from its outbreak in the Lodi area has shownhow hospitals are the places most at risk at the moment. The government shouldtherefore stop unnecessary hospital services in this moment of emergency, toprotect people and medical personnel from infection and maximise the scarceresources in the public health system. Yet this is not happening with medicalabortion. It is time to introduce abortion care by telemedicine in Italy.
In Italymedical abortion is available only in the first 7 weeks with hospitalisation forthree days. Some regions use a day-hospital regime for medical abortion. Thesebarriers to accessing medical abortion are justified on grounds ofprotecting women’s health. Yet, curettage is still practiced in Italy (e.g. in41% of cases in Sardinia), while medical abortion is used only in 18% of cases.
We have observedhow the pandemic provides a legal basis for strong limitations on our freedoms.Extraordinary measures for supplying abortion pills can be arranged on the samebasis. Considering all the interests at stake, it is time fortelemedical abortion.
Abortion services are now stopping in Lombardy. This istestified by Sara Martelli, coordinator of the Safe Abortion campaign:“Abortion services are stopped at three hospitals, and at a fourth, medicalabortion provision was interrupted. Many departments in Milan are nowdedicating beds to COVID-19. There are other hospitals in Lombardy that havehad to close their abortion clinics and almost half of the healthcare centresare closed in Milan. The situation is constantly changing and it is almostimpossible to obtain information. What is happening highlights not only theusefulness of de-hospitalising medical abortion [to local healthcare centres],which is supported by AOGOI,the Italian Hospital Gynaecologists & Obstetricians Association, butalso the need to have a regional information and coordination centre. Elsa Viora, president of AOGOI says:”The change of the upper limit from 7 to 9 weeks is a request already madeto AIFA (Italian Medicines Agency). In almost all countries where the abortionpill is used up to 9 weeks, there is no increase in complications. But todaythe system has been suspended because medical abortion involves returning tohospital twice for the two kinds of pills, while surgical abortion is resolvedin one day. Certainly a rule that requires hospital provision of medicalabortion is ideological, not based on scientific evidence; so the goal is tochange it. Anna Pompili and Mirella Parachini, gynaecologists of the Associationof Italian Doctors for Contraception and Abortion, wrote in a recent letter to Quotidiano Sanità, “In many centresaround the world, procedures have been implemented with telemedicine services,which have given excellent results.”
Il fatto quotidiano, by Eleonora Cirant, Pro-Choice Networkmember, 26 March 2020 ;
La 27esimaora,Corriere della Sera, byElena Caruso, PhD student, KentLaw School, UK, Marina Toschi, Gynaecologist, European Society ofContraception & Reproductive Health, 26 March 2020 ; English translation from Italian, by Elena Caruso
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LUXEMBOURG
Malgré la crise ducoronavirus, le Planning familial essaye de garantir ses services en ayantrecours au téléphone, à Skype et aux mails
(Despite thecoronavirus crisis, Planning Familial will try to guarantee its services bytelephone, skype and emails)
Family planning is a medicalservice, so it is not closed and will not be closed. The services have beenadapted to the situation. Meetings, for example, are organized via Skype andpsychological and sexology services are provided by phone or Skype as well. Advisoryand support services continue to operate. It is particularly important thatpeople who need help because they are victims of domestic violence can behelped immediately. To do this, there is the address “Violence.lu”.In an exceptional situation like this, the number of cases is likely toincrease.
5 minutes,17 March 2020