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Why Self-Managed Abortion Is So Much More Than a Provisional Solution for Times of Pandemic

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Why Self-Managed Abortion Is So Much More Than a Provisional Solution for Times of Pandemic Sexual and Reproductive Health Matters ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/zrhm21 Why self-managed abortion is so much more than a provisional solution for times of pandemic Mariana Prandini Assis & Sara Larrea To cite this article: Mariana Prandini Assis & Sara Larrea (2020) Why self-managed abortion is so much more than a provisional solution for times of pandemic, Sexual and Reproductive Health Matters, 28:1, 1779633, DOI: 10.1080/26410397.2020.1779633 To link to this article: https://doi.org/10.1080/26410397.2020.1779633 © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group Published online: 30 Jun 2020. Submit your article to this journal Article views: 192 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=zrhm21 COMMENTARY Why self-managed abortion is so much more than a provisional solution for times of pandemic Mariana Prandini Assis ,a Sara Larrea b a Postdoctoral Fellow in Harm Reduction as Public Policy, Schulich Law School, Dalhousie University, Halifax, Canada. Correspondence: [email protected] b Research Coordinator at Women Help Women, Amsterdam, the Netherlands and PhD Candidate in Biomedicine at Universitat Pompeu Fabra, Barcelona, Spain Keywords: abortion access, COVID-19, self-managed abortion The COVID-19 pandemic is striking health care sys- While advocates in the field of reproductive tems around the world through an unprecedented health and rights have celebrated the UK’s decision increase in demand. In responding to this crisis, and are encouraging governments across the world governments and health care providers face the to follow suit, the new regulation is temporary. challenging question of how to continue providing Adopted in light of the mandatory lockdown, essential health services, while taming the new dis- access to abortion through telemedicine will last ease. In these times, access to abortion is more for two years or until the end of the pandemic, contested than ever. whichever is earlier.4 The assumption underlying Conservative governments have seized upon the the regulation and, indeed, the field of public pandemic as an opportunity to declare abortion health in general, is that once the coronavirus cri- an elective procedure and shut down services. In sis is over, people should go back to having abor- the USA, where abortion rights have again become tions “as usual”, i.e. in formal health facilities. a heated topic, several states have imposed restric- Even in these extraordinary times, medical control tions on access that amount to effectively banning of abortion remains the prevailing principle. abortion care.1 In Latin America and the Caribbean, The history of abortion medicalisation is a rela- a region with the most restrictive abortion laws in tively recent one. For centuries, abortion was routi- the world, activists have exposed added difficulties nely used to regulate fertility, along with “calendar- faced by those who qualify for abortion on the based” contraception and other methods then few grounds where it is legal.2 In Poland, a country available. Even after the ban of abortion, the prac- with some of the strictest abortion laws in Europe, a tice remained common within women’s circles, and controversial tightening legislative proposal has midwives were a central figure in family planning been pushed through during the lockdown.3 services. Only in the nineteenth century was law In an alternative approach, a few countries invoked to regulate abortion provision. Physicians have acknowledged that abortion is an essential were among the loudest voices calling for such regu- health service and shifted to telemedicine to lation, which eventually extended medical jurisdic- secure access during the crisis. After much discus- tion to a life event that, for centuries, had been sion and public confusion over prematurely under people’s control and happened within their leaked regulations, the United Kingdom adopted intimate circles of care.5 guidelines that allow women and pregnant The relaxation of abortion regulation that is only people to manage their own abortions. According a temporary response to a health crisis ignores this to the new regulation,1 the person in need of past history. It also assumes that the more recent abortion care can have a telemedicine consul- experiences of self-managed abortion – that is, tation with a registered medical practitioner, the use of abortion pills outside formal health facili- receive the pills (mifepristone and misoprostol) ties without medical supervision6 – is abnormal and by mail, and use them at home. less desirable. Such an approach overlooks much of © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group 1 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http:// creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. M. P. Assis, S. Larrea. Sexual and Reproductive Health Matters 2020;28(1):1–3 what we already know about the relationship Feminist activists have demonstrated that self- between self-management, increase in abortion managed abortion support initiatives are indeed access, and safety and quality of methods. so much more than a provisional solution. People Extensive research today shows that self-admin- report preferring self-managed abortion because it istration of pills for early abortion with limited fosters privacy, autonomy, and confidentiality.6 involvement of health professionals is effective The method also allows pregnant people to be at and has similar outcomes to medical abortion home or in any space of their choice, surrounded administered by professionals in health facilities.7 by those whom they trust. And above all, self-man- Moreover, the use of abortion pills outside of for- aged abortion puts control over the process back mal systems is credited with the decrease of abor- into the hands of pregnant people. tion complications and maternal mortality Women and gender non-conforming people worldwide, but particularly in low- and middle- have long struggled for the demedicalisation of income countries.8 For a vast number of women their bodies and health. Yet, public health and pregnant people across the world, self-mana- approaches usually do not consider autonomy ged abortion is not a provisional solution; it is and control over medical processes as indicators indeed the best option. of quality of care. The advent of abortion pills For decades now, feminist organisations around opened up the possibility of realising the political the world have supported pregnant people in self- demand for autonomy, at least in abortion care. managing their abortions, especially in places Seizing this opportunity, feminist initiatives on where abortion is restricted by laws and regu- self-managed abortion show us what demedica- lations, stigma, or lack of resources. Building on lised, respectful, and dignified care that enables the knowledge first developed and disseminated people’s power looks like. by Brazilian women in the 1980s, feminist initiat- Indeed, the stories behind the feminist initiat- ives for self-managed abortion have created ives on self-managed abortion speak of solidarity diverse frameworks of knowledge and resources and non-judgmental support,5,6 experiences that that operate both locally and within a transna- pregnant people, particularly those from margina- tional network. People access abortion pills online lised communities, do not always encounter in for- or in local pharmacies and activists provide them mal health systems. Every person, regardless of with evidence-based information on how to effec- their context, deserves good quality abortion care tively and safely use the pills, as well as assistance when choosing to terminate a pregnancy, and throughout the process. access to emergency medical attention if needed. The ways that activists provide support vary, but They should be able to decide also how they they all share an underlying commitment to femin- want to have their abortion, without fear of prose- ist ethics. Socorristas en Red is a nation-wide Argen- cution or moral judgement: in a formal health tinian network that provides access and facility, overseen by a health professional, or at a information through telephone and in-person place of their choice, with accessible information accompaniment and group meetings.9 In Africa, and care from whomever they cherish. It is now MAMA, a network of grassroots activists and femin- up to national governments and formal health sys- ist groups, works towards expanding knowledge tems to take the opportunities brought by COVID- and eliminating stigma around self-managed abor- 19 and make permanent improvements that are tion at the community level. Samsara, in Indone- long overdue in abortion provision. sia,10 similarly to activists in many countries in Abortion care needs to be contextualised in Latin America and the Caribbean,11 operates a relation to local sociopolitical circumstances and safe abortion hotline that offers information tailored to personal needs and preferences. This about self-managed abortion with pills in countries means that there is no universal formula for where abortion is criminalised. Women Help improvement. However, some simple measures Women and Women on Web both run telehealth could have vast impact on abortion access and services that deliver access to pills, as well as infor- quality of care. For example, decreasing barriers mation and accompaniment over email to people to access abortion pills, such as regulations that all over the world.12 By doing this essential work, restrict distribution and use to authorised health feminist activists fulfil a need that is often neg- facilities or that require prescription for purchase lected or denied by many states in “normal” in pharmacies, could improve accessibility and times, and even more so in times of a pandemic. safety. Eradicating censorship of online abortion 2 M.
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