Covid-19: Exposing the Fault Lines of Abortion Care
Frances Walker, BA in History at McGill University and
MSc in Health and International Development at the London School of Economics
The need for abortion-related services and care does not decline during times of self-isolation and quarantine. COVID-19 provides a pertinent example on how we consider the impact of health emergencies on how people make decisions on abortion-care and access healthcare. Previous disease outbreaks have shown us that health emergencies have effects on sexual and reproductive health, on people’s ability to access services, and on their reproductive health decisions, such as taking contraceptives or terminating a pregnancy. During the 2013 Ebola outbreak in West Africa, for example, many women were unable to access vital maternal health and prenatal care services, likely contributing to the substantial increase in maternal, neonatal and stillbirth deaths across the region. The Zika virus, in 2016, drew worldwide attention to the neglect of women’s reproductive rights, especially in public health responses. In Brazil, there were clear linkages between the location of microcephaly cases (in poorer and remote locations) and the lack of access to contraceptives and abortion-related care. Similar effects have been seen when we consider Covid-19, though the global scale of the outbreak creates need for global health agencies and governmental bodies at all levels to consider sexual and reproductive health and rights (SRHR) at all stages of a public health response. Thus far, many countries have (tacitly or actively) ignored SRHR, especially abortion.
A Foreboding Picture
The international response to Covid-19 appears to have drawn upon some lessons from previous outbreaks. Feminist and gender experts from the UN, CARE International, WHO and other prominent international and multilateral organizations point to how the pandemic is exacerbating existing inequalities, with vulnerable populations being further marginalized. Various gender analyses and published data show that economic and secondary health impacts will be especially severe for women. With regard to abortion care, the pandemic has had an unprecedented impact. National lockdowns, resulting movement restrictions, lack of clear information, supply chain disruptions, and overwhelmed health systems ensures that barriers to safe abortion-related care are intensified in both the Global North and the Global South. As the Guttmacher Institute shows, this could lead to millions of unsafe abortions. Marie Stopes International, an international NGO providing SRH services (including safe abortion) across the world, published a report showing that 1.9 million fewer women were served by its programs, potentially leading to 1.5 million additional unsafe abortions and 3,100 additional maternal deaths. Despite consistent evidence showcasing its necessity, abortion-related care has not been adequately considered within public and global health responses. Where abortion is mentioned, the advocacy and recognition for safe abortion care is not always stated. Governmental responses are not much better – some governments have declared abortion services as “non-essential,” halting abortion care. The potential economic, social and political consequences of these decisions remain to be seen.
Is COVID-19 an opportunity for abortion self-care?
Even though predictive models are stark, civil society organizations, NGOs and feminist activists and local collectives have responded to the crisis using innovative strategies. One method is promoting abortion self-care through self-administered medications and digital technologies allowing for the dissemination of accurate information. Abortion self-care (sometimes referred to as self-managed abortion or medical abortion) is a preferable method for many, as it fosters privacy, autonomy and confidentiality. The necessity of abortion self-care has been amplified by the pandemic, as many SRH clinics have been forced to close and many people have been required to self-isolate. Social media has also been leveraged to ensure that accurate and safe information is being shared. While essential, abortion self-care does not address all the barriers in accessing care. The medication is not legally available in all countries and COVID-19 has created delays and disruptions at every stage of the supply chain, meaning that stockouts are reported in several countries. Even if the medication is available, many are still unable to access it for a variety of reasons.
Finally, ensuring access to one’s choice of method is essential as many may still prefer surgical abortions. What is needed most is political will from governments and global health agencies to ensure that abortion-related care is not neglected in this time of crisis. Public health responses to COVID-19 must consider the intersection of sexual and reproductive healthcare and health emergencies to ensure that people are still able to access the healthcare they desire.
References
Ahmed, Z., & Cross, L. (2020). Crisis on the Horizon: Devastating Losses for Global Reproductive Health Are Possible Due to COVID-19. Guttmacher Institute2. https://www.guttmacher.org/article/2020/04/crisis-horizon-devastating-losses-global-reproductive-health-are-possible-due-covid#
Haneef, C., & Kalyanpur, A. (2020). GLOBAL RAPID GENDER ANALYSIS FOR COVID-19. https://www.rescue.org/sites/default/files/document/4676/globalrgacovidrdm33120final.pdf
IASC. (2020). Interim Guidance: GENDER ALERT FOR COVID-19 OUTBREAK (Issue March). https://resourcecentre.savethechildren.net/node/17253/pdf/iasc_interim_guidance_on_covid-19_-_gender_alert.pdf
Kohn, I. (2020). ONLINE ABORTION IS THE NEXT FRONTIER OF THE COVID AGE. Mel Magazine. https://melmagazine.com/en-us/story/online-abortion-is-the-next-frontier-of-the-covid-age
Sochas, L., Channon, A. A., & Nam, S. (2017). Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone. Health Policy and Planning, 32(suppl_3), iii32–iii39. https://doi.org/10.1093/heapol/czx108
UNFPA. (2020). COVID-19: A Gender Lens. https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_A_Gender_Lens_Guidance_Note.pdf
WHO. (2020). Gender and COVID-19: Advocacy brief. https://apps.who.int/iris/bitstream/handle/10665/332080/WHO-2019-nCoV-Advocacy_brief-Gender-2020.1-eng.pdf?ua=1
About the Author
Frances Walker completed her BA in History at McGill University and her MSc in Health and International Development at the London School of Economics. Her global health interests include health policy, sexual and reproductive health, and social determinants of health.