Abortion Care In Lockdown
Updated: Jul 30, 2020
The Covid-19 pandemic has had and will continue to have far reaching and unpredictable consequences for all elements of our lives. One consequence we could have all predicted and are still seeing, is the upheaval and pressure exerted on our health care systems. Elective operations being cancelled, routine appointments rearranged, cervical smear tests being missed due to fear of catching or spreading Covid-19; the list goes on. However, one aspect of healthcare which received a welcome change during this time of uncertainty was in abortion care.
In March this year, the Government and Public Health England announced that women seeking an abortion would be able to access early medical abortion care after an e-consultation or telephone consultation with an appropriate medical professional. This step was an important and necessary development in women’s health to ensure that safe abortion care could continue despite the restrictions on travel and face to face interactions imposed during lockdown. Initially, the announcement was made in error, with the post being deleted within a few hours of its publication. However, further announcements the following week, confirmed the easing of the abortion laws and women were now able to have both sets of abortion pills sent to them in the post or could pick them up without a face to face consultation.
This simple yet dramatic change in abortion law would not only help to reduce pressures on the health system, as medical professionals could potentially counsel and prescribe from the safety of their own homes but would also reduce the risk of exposure for health care workers as well as women seeking an abortion as it limits the amount of face to face interactions needed. In the trust I have been working in, women seeking a medical abortion must still speak to one if not more health care professionals and must reach certain criteria to be able to receive the pills in the post (for example, being fairly certain of dates of last menstrual period, being 10 weeks or less in gestation and not meeting criteria for needing a scan to confirm gestation or site of pregnancy, for example cramping pains or bleeding). Furthermore, follow up is still rigorous and a minimum of two further telephone calls as well as offers for further counselling, to ensure the completion of the termination of pregnancy as well as the physical and mental health of the woman, is standard practice. These changes are safe.
I am a junior doctor working in the NHS and qualified in July last year. Since then I have been working mainly in acute medicine and surgery, trying to learn as much as I can in my first year of practice. During this time, I have also tried to use any spare study time to gain further experience in the fields of sexual and reproductive health and abortion care. My experience of working in an abortion clinic during lockdown has taught me so much but has also highlighted the difficulties that women still face in accessing care. During lockdown although pills could have been sent to women in their own homes, there are still challenges that arise from this situation. For example, some women not wanting the pills to be sent to them as they have not told their partner or their parents, not being able to travel to the clinic to pick up the pills due to lockdown restrictions and ironically, not being able to have that face to face conversation with a health care professional might mean the woman cannot fully explore her anxieties and questions surrounding abortion.
From what I have seen though, these changes to the law have largely been a positive experience. Firstly, for myself, for the first time in the whole year I have been practising medicine I feel like I am finally in an environment where I’m consistently doing well and helping people to the best of my abilities as I am afforded the time needed to give to each woman. The team is well staffed with people who care about the women and believe in what they are doing. I feel like we are well resourced, and women come away feeling like we have helped them. Most importantly however, the women can access abortion care easily (women in this trust can now self-refer to the service), quickly, without judgement and without having to put their health at risk unnecessarily. Although a telephone call or e-consultation cannot replace the rapport gained in a face to face interaction, the balancing act of being able access safe abortion care without increasing the risk of exposure to Covid-19, must be constantly reassessed.
Contraception is another element of women’s health that we approach in these telephone and e-consultations and is another aspect of healthcare which has been impacted on due to Covid-19. For a myriad of reasons, from lack of funding, to coil fittings being cancelled, to women running out of the pill, to travel restrictions, contraception has been a struggle for some women. Therefore, it is unsurprising that abortion care would necessarily become part of the equation for women’s health. During these consultations we ask what contraception women would like to use after the abortion and we offer the combined and progesterone only pills as both long term and interim methods whilst women try and get an appointment for a LARC (Long Acting Reversible Contraceptive) if they so wish. It is simple really. If we don’t get women’s contraception right and even acknowledge that there is a problem with access during the pandemic, then women are going to need to access abortion services more and if that is the case, then accessing services should be safer and quicker for women. The Telemedicine consultations help to facilitate that.
My hope in writing this article and in your reading it, is not to change your opinions of whether you think abortion is right or wrong, (that’s quite a tough ask in just a 1000 words) but for you to consider the wider ranging consequences of Covid-19, beyond what has affected you. And to also consider that abortion care does not always fit the narrative in your head which has been constructed by years of conditioning and teen soap operas. In the short amount of time I have spent in abortion care I have seen all facets of the spectrum and all kinds of reasons why women wish to have an abortion. I think of the young woman who has yet to really begin her life and is not ready to be a mother. I think of the older woman who has already completed her family and feels another child is not right or even safe for her to have. I think of the woman who had such awful pregnancy sickness in her last two pregnancies that she had to be hospitalised. I think of the woman in an abusive relationship who cannot see a way out if she has her partner’s child. I see the woman who simply forgot to take the pill and I do not think she should have to compromise the rest of her life for one error and not be able to just move on, just like a man can. I see all these women and believe every one of them should be able to access safe abortion care, whatever extraordinary circumstances we are living in.
About the Author
Hi! I’m Anhya and I am a junior doctor living and working in Cornwall with a passion for women’s health, rights and ownership of their own bodies. I am a member of Doctors for Choice UK and am hoping to get involved in their social media working group over the coming year. I studied in London for 6 years, but the call of the sea and fresh air brought me back home. Whilst there are less opportunities to get involved in amazing charities like Ditch the Rag back in Cornwall, I’m determined to get the message out that equity in all aspects of women’s health, be it period poverty, abortion care, contraception, cervical smears etc are paramount in making a fairer, better society. When I’m not at work I can found wishing I were a mermaid at one our many amazing beaches or sitting with a pint in hand overlooking a pretty harbour, in my home county.