Ensuring safe abortions for women during COVID-19

The Government of India has recognised safe abortion as an essential service during the COVID-19 outbreak. Anisha Aggarwal, Senior Director – Strategy and Development, Ipas Development Foundation explains how telemedicine can be of help to women for availing safe abortions

The COVID-19 pandemic is pressure-testing systems and abilities at all levels – of leaders, of the economy, of industries, of health facilities and service providers, of the community at large. Amidst world leaders strategising to save lives, prevent the spread and save the economy, many are of the opinion that a woman with an unwanted pregnancy restricted at home and unable to access an abortion service, does not deserve much thought.

Quite appreciably, the Ministry of Health and Family Welfare (MoHF&W) recently released a guidance note for ensuring provision of essential health services during the COVID-19 outbreak – this includes reproductive health services and enlists safe abortion services as essential. The guidance states that all appropriate health facilities should ensure provision of medical and surgical abortion services, with appropriate infection prevention measures comprising counselling for post-abortion care and provision of contraception. The need of the hour is to ensure that this guidance is widely disseminated and implemented across all levels of the health system – but the guidance also raises some pertinent questions on access and availability.

Abortion in India, though legal, is highly stigmatised. It is estimated that approximately 1.5 crore abortions take place in the country every year and so the need for ensuring immediate access to safe abortions is quite established. Denial or delay of an abortion is not an option. This can lead women to seek services from an untrained provider damaging her health and body; it can also increase the burden on the health system that will have to cater to emergency complications of an incomplete abortion. Telling women to delay their abortion will only increase their requirement for a late-term abortion – something that is more complicated and less available.

However, at a time when the country is in an extended lockdown, movement is highly restricted and public transport services are not available; how is a woman in need of an abortion to reach a health facility, especially in a context where her mobility is restricted even in normal times and she does not have support for an abortion? Even if she manages to reach, is it safe for her to wait to see a doctor who is surely not expected to prioritise her need in these times? Given the nature of the pandemic and the treatment course it requires, health facilities are stretched to their limits in places where the outbreak has been significant.

Most secondary- and tertiary-level facilities have either been converted to dedicated COVID-19 hospitals or have a considerable number of beds dedicated for it. Majority of doctors and nursing staff have been redeployed for care and treatment of COVID-19 patients. There has mostly been a decline in OPD caseload across all levels of health facilities. This does not point to the gaps in the health system but is just a reiteration of the intensity of crisis we are facing.

Given this context, where an in-person client-doctor meeting is both risky and difficult, and denial or delay of services can have adverse outcomes, I strongly believe that it is time to harness the potential of telemedicine for abortions. Telemedicine can make it possible for women to undergo legal abortions with the opinion, and under the guidance of a trained abortion provider. With the advent of medical abortion, providers can assess women with some key questions to determine whether they are eligible to terminate their pregnancy via medical abortion – the whole process can be contactless, safe, and legal. For instance, currently, the United Kingdom (UK) has allowed abortion services via telemedicine. This means that women who need an abortion can consult with a registered abortion provider via telephone or video call and use pills to manage their abortion at home, under the supervision of the provider.

The Niti Aayog, in a recent publication, says that though telemedicine will not solve all the challenges posed by a pandemic, it is well for scenarios in which medical practitioners can evaluate and manage patients. Telemedicine practice can prevent the transmission of infectious diseases reducing the risks to both healthcare workers and patients.

So, telemedicine for abortion has multiple advantages – it can allow a woman to access expert advice from the safety and privacy of her home and prevents her from reaching a situation where she will likely need a more complicated and expensive abortion service.

Covid-19 is an extraordinary challenge – and it requires a commensurate response, India has shown that it cares for its people beyond just the immediate impact of the pandemic. It has shown that it recognises women’s need by stating that abortion services are essential and urgent; it is encouraging doctors to consider the use of telemedicine as a part of normal practice. So, when with advances in technology, it is possible for women to manage their abortion at home (through medical abortion) under the guidance of a registered medical practitioner, there should be no delay in expanding the scope of telemedicine to include abortion services. Other countries have done it and India can, too. This will only add to translating the government’s vision to reality; and will save the women of this country from potential damage to their health and body.