Currently in the UK, a pregnant woman cannot simply take the decision to end her pregnancy. For an abortion to be legal in England, Scotland and Wales, it must be administered by a registered medical doctor or specialist nurse; a woman cannot complete her course of abortion pills, for example, in her own home. Two doctors must also confirm that the woman meets the criteria laid out in the 1967 Abortion Act, which stipulates that the abortion must pose a risk to the physical and/or mental well being of the woman. Then there is the requirement that two doctors sign the abortion form, which already presents a challenge to abortion services operating in more remote parts of the country.
Coronavirus is jeapordising women’s access to abortion even further; already, abortion services in some hospitals are struggling to keep up with demand. The government has suggested changes to medical provision in areas other than abortion in the most recent coronavirus bill, including scrapping the need for a second confirmatory medical certificate in order for a cremation to take place, and requiring only one doctor (rather than two) is to section a mentally unwell patient. If the purpose of these changes is to enable medical treatment while facilitating social distancing, why isn’t the same approach being taken to abortion provision?
Yesterday, the Department of Health & Social Care (DHSC) appeared to agree and announce new measures to permit women to take mifepristone (a drug that initiates the first stage of medical abortion) from their homes, thereby reducing the need for face-to-face consultations. However, this statement has since been deleted, leaving many abortion providers confused. At a time like this, both providers and patients require clarity and security – we seem to be receiving anything but.
During the coronavirus outbreak, it is likely that we will see an increase in demand for abortion, for a number of reasons, including economic hardship, relationship breakdown and lack of access to contraception. Given this, it is vital that we maintain safe and effective abortion care during this critical time. Lead organisations including the Royal College of Obstetrics and Gynaecology and the Faculty of Sexual & Reproductive Health have produced clear guidance for abortion providers, and it is time that the government does the same.
Dr Jayne Kavanagh, co-chair of Doctors for Choice, says that “unless the requirement for two doctors to authorise an abortion is lifted, women across the country will be forced to continue their pregnancies against their will. In these unprecedented times doctors, nurses and midwives must be allowed to do their jobs unhindered by clinically needless administrative burdens.” Doctors and nurses at the front-line of abortion care are already able to see the poor outcomes and unintended consequences on women’s rights if we fail to account for abortion care now and incorporate it into the current coronavirus bill.
In the US, pro-life politicians have exploited the chaos created by coronavirus to push to curtail abortion access. Both Texas and Ohio providers have both been told to stop abortion unless it endangers a women’s life, despite evidence that shows that without adequate abortion provision, maternal mortality increases substantially due to unsafe measures taken to end a pregnancy. The UK has an opportunity to be a beacon of hope during these incredibly dark times, and to safeguard the reproductive rights of its citizens when others will be seeking to remove them.
The British Pregnancy Advisory Service (BPAS), the largest provider of abortion care in the UK, has launched a campaign to help members of the public contact their MPs about amending the current coronavirus bill to allow one medical professional to sanction abortion, and allow telemedicine consultations for patients. These changes, if made, will ensure that those requiring abortion care continue to access good quality care, and that nobody is forced to continue a pregnancy during the coronavirus pandemic. Now is a time when many of us feel out of control of our bodies; let us not disempower women even further.
Annabel Sowemimo is a sexual and reproductive health doctor.