Opinion

From ‘Published in Error’ to positive change: a respite for reproductive rights

Whilst on the surface this global crisis may have generated a cohesive sense of community, points of political contention have taken on new colours in the face of the novel pandemic. Abortion has recently become centre focus, as the UK government has fumbled over emergency measures for women’s reproductive health. Monday heralded some much-needed positive news, as a temporary change to abortion law was instated to allow women to conduct medical terminations without travelling to a clinic; despite being previously published and rapidly retracted, the affirmation of this forward-looking policy promises to protect the well-being of thousands of women around the country.

Widespread national lockdowns and over-strained healthcare systems make a mentally and physically taxing process become yet more difficult, as thousands of women are forced to make increasingly difficult decisions when faced with an unwanted pregnancy. 

Standard regulations in the UK require signatures from two doctors and an in-person consultation to administer the first of two pills to medically terminate a pregnancy, the second of which can be taken at home. This process inevitably requires multiple points of human contact, and clinic closures may force women to travel extended distances and thus increase risks of contracting and spreading COVID-19 .

On 23 March, the Secretary of State for Health and Social Care approved emergency measures relating to abortion regulation which would have revolutionised abortion practice in England. ‘Telemedicine’ was endorsed as a suitable emergency measure to support women’s reproductive needs. Women would be able to take both pills at home, following a virtual consultation via phone or Skype. What promised to be a major breakthrough for emergency management of COVID-19 in accordance with women’s needs proved short-lived. Within five hours of the announcement, the statement was wiped from Gov.UK, replaced with the following: ‘This was published in error. There will be no changes to abortion regulation’.

Women’s health organisations and reproductive rights groups responded to this U-turn with dismay and anger at the lack of explanation, urging the government to reinstate this policy that would have enabled tens of thousands of women to access early abortion care lawfully at home, protecting their own health, that of their families, and that of the doctors, nurses and midwives who care for them. It is predicted that over the estimated length of lockdown in this country, 44,000 women will require an abortion; that’s 500 women every day, forced to break lockdown (if they are able), and the numerous healthcare professionals these women will come into contact with, all at risk. 

No indication or discussion was offered as to why this motion was reversed; coming under fire in the House of Commons the following Tuesday, Matt Hancock denied that there had been any plans to change abortion rules, despite MPs pointing out that the liberalization of the law had been agreed with a swathe of medical groups. 

‘Telemedicine abortion’ has been deemed safe and successful in a number of countries, according to the WHO 2018 Guidance on Medical Management of Abortion. In Scotland and Wales, women are already allowed to collect both pills to take home and self-administer. There is evidence to show that the medications can be safely provided using telemedicine, and that there are no greater safety risks to taking the medications at home. In light of this, the reversal of this policy appears to have been enacted to prioritise other political concerns over the interests and well-being of women. It is worth noting that opposition to abortion remains strong on the Conservative benches. Last July, 70 voted against lifting the ban in Northern Ireland, with dozens more abstaining. 

Policy-making on abortion has a history of ignoring clinical evidence, but an effective campaign response from health experts, campaigners and journalists alike have made it impossible for the government to deny the medical and moral force for the case for early abortion care at home. On 30th March the Department of Health and Social Care reinstated the policy on the temporary basis of two years. Women who find themselves with an unwanted pregnancy will no longer be forced to choose between exposing themselves or healthcare workers to the risk of infection with COVID-19 in clinic waiting rooms, to continue with a pregnancy they do not want, or to take even more drastic measures. Limiting unnecessary in-person interaction with health services will additionally remove some strain on NHS workers and facilities already at breaking point. Implementing these evidence-based methods of providing reproductive health care will benefit all involved. 

Far from a ‘trojan horse’ to go beyond the 1967 Act and permanently give women greater autonomy (God forbid), this legislation is a much needed intervention to uphold the rights and well-being of women who need abortions in the current climate. There is certainly further debate to be had surrounding the framework we use to make decisions about abortion and why we still insist on treating women as second-class citizens when it comes to their own healthcare. For now, a temporary relaxation of UK abortion law is welcomed.

Developments elsewhere prove rather more disheartening; in the US, social conservatives have taken advantage of the pandemic to further many politically divisive policies. Texas and Ohio have issued state-level bans on “elective” abortions under the guise of protecting the interests of public health. Anti-abortion groups and government officials appear to shamelessly harness the coronavirus crisis to infringe on women’s constitutional rights and prevent abortions occurring.

Both states have long histories of trying to restrict abortion. In 2016, the U.S. Supreme Court struck down a Texas law that the court found would have forced half of the state’s abortion clinics to close. Similarly, an Ohio ban on abortions after six weeks of pregnancy was quickly struck down last summer by a federal judge for being “unconstitutional on its face.” Recent ‘emergency legislation’ proves to be just another chapter in such unconstitutional behaviour, as states use COVID-19 as a cover to restrict reproductive rights. 

A letter signed by the heads of of 52 anti-abortion advocacy groups further illustrates this broader theme. The groups called for restrictions on medication and surgical abortion providers in order to “free up much needed medical equipment” and ease an alleged strain on emergency rooms stemming from patients with complications from abortion care. Not only are complications from abortion care very rare, but a letter of demands for the Department of Health and Human Services indicates that, unsurprisingly, motivations go beyond protection of public health. These demands include ensuring that emergency response funds are not given to abortion providers, urging abortion providers to cease operations in order to preserve personal protective equipment (PPE) for treating COVID-19 patients, not expanding telemedicine for medication abortion access, continuing actions to stop mail-order abortion prescriptions, and demanding the promotion of ‘medically accurate’ information (by their own definition) to counter the ‘inaccurate and exploitative messaging’ from organisations such as Planned Parenthood. 

Frustratingly, there seems to be the need to reiterate a fact which many of us with wombs will consider blatantly obvious; abortion is essential and time-sensitive healthcare. It is a legal right and it must be protected as such. Legislation does not impact a person’s need for an abortion, or their commitment to obtaining one. All it means is that women might be forced to consider illegal or unsafe abortion methods, which directly increases social, legal, and health risks to these women, particularly for those on lower incomes who may have less means to travel long distances to open clinics. As pointed out by Kellie Copeland of NARAL Pro-Choice Ohio, “people decide to end their pregnancies for a complex constellation of reasons that include the impact of pregnancy and birth on their health, ability to work, and strained economic circumstances. These are conditions that do not go away – and are likely heightened – in pandemic conditions”.

Evidently, a public health emergency is not the time to play politics. With self-isolation placing barriers to accessing services, a looming global shortage in contraception, and for some women, an increase in the risk of pregnancy as a result of domestic sexual violence, this is a matter which is bound to become increasingly pressing. As with all emergencies, COVID-19 allows for a time for regulatory pause, change, and reflection. Although anti-abortion advocates continue to use the pandemic to their advatage in the US, new policy in the UK will dramatically improve women’s access to care at this time of national crisis, and provides hope for the future of broader discourse.