Opinion: During COVID-19 crisis, lift barriers to reproductive health care — including abortion

As COVID-19 spreads worldwide, upending life as we know it, governments around the globe are facing massive challenges in containing the new coronavirus and protecting lives. But even in this time of crisis — in fact, especially in this time of crisis — pregnancy care, including abortion care, remains an essential health service.

Abortion is time-sensitive and cannot be significantly deferred without profound consequences for women and their families. While conservatives in the U.S. have pounced on the political “opportunity” that the coronavirus pandemic presents to advance their ideology, countries in the global south are struggling to meet all the needs of their citizens, including the need for safe abortion care.

According to Ipas country directors, women in India — where the greatest number of people in the world are under lockdown — can’t get to health facilities, and in Zambia, visits to health facilities are discouraged. Meanwhile, the organization’s country director for Nepal, where there is a nationwide lockdown, reports that accessing contraception and safe abortion may not be a priority for most families, as men generally make decisions about travel and the use of contraception and abortion. He warns that this sets the stage for more unwanted pregnancies and unsafe abortions.

A recent report from the Guttmacher Institute paints a bleak future: a 10% decline in contraceptive use would leave an additional 49 million women without access to modern contraceptives. And, the researchers say, if 10% of safe abortions become unsafe because women cannot access safe abortion services amid lockdowns and clinic closures, there would be an increase of 3 million unsafe abortions and 1,000 more maternal deaths.

All of this urgently points to the need for quick and decisive action by political leaders to not only prioritize reproductive health services, but to lift legal and clinical barriers to reproductive health care, including abortion services.

This is not an extreme position, but one based on experience and data. Women continue to need abortion and contraception, perhaps even more urgently. Women and girls in refugee camps and other humanitarian settings are at an increased risk of unplanned pregnancy and unsafe abortion for many reasons — a lack of social and family networks, disruptions in access to contraceptive supplies, and higher rates of sexual violence.

And even women who are not displaced from their homes may face a crisis-related threat: domestic violence, which can lead to sexual violence and unwanted pregnancy. As The New York Times has noted, the coronavirus outbreak has led to a rise in domestic abuse worldwide, with domestic abuse itself “acting like an opportunistic infection, flourishing in the conditions created by the pandemic.”

Another serious threat to women’s health and rights is that abortion may be deemed a “nonessential” health service. So how can governments and health care providers responsibly act on behalf of women and girls during this crisis?

Here are some actions they should take:

• Follow the U.K.’s lead in lifting regulations on abortion with pills during the pandemic. Women can have an abortion with pills at home after a telephone call or digital conversation with a health care provider, rather than taking the first dose at a health care facility. Research and evidence show that women can safely and effectively manage their own abortions with pills — mifepristone-misoprostol or misoprostol alone — when they have accurate information about the dosing regimen and when to seek treatment for complications.

• Allow pharmacists to give women abortion pills in the correct dosage, along with vital information, so that women can safely end a pregnancy at home without the need to go to a health facility.

• Integrate services for abortion with pills into telemedicine programs that offer primary care services. This is a key step, since telemedicine is being more widely used during the pandemic.

• Loosen legal restrictions on abortion self-care, in which a woman uses pills without a prescription to manage the abortion process on her own, with or without the involvement of a health provider. Laws in many countries penalize abortion self-care, despite proof of its safety and effectiveness. Abortion self-care is already on the rise worldwide due to the availability of simple, safe, and highly effective medications. This current public health crisis dramatically shows the need for laws and regulations that allow for safe abortion with pills, on a woman’s own terms.

As this pandemic continues to take the lives of tens of thousands of people around the world, the health and well-being of everyone is at stake. Governments need to look out for everyone — including the people who need an abortion.